Specific affinity-chromatographic measurement of glycated hemoglobins in uremic patients.

Abstract

The clinical utility of glycated hemoglobin measurements in renal failure is controversial, given numerous earlier studies showing no correlation between glycated hemoglobin and other indicators of blood glucose control in uremic subjects. This problem is attributable, in part, to analytical interferences from carbamylated hemoglobins. We report use of a specific affinity method to measure glycated hemoglobins in a group of uremic patients, diabetic and nondiabetic, undergoing treatment by continuous ambulatory peritoneal dialysis. Concentrations of glycated hemoglobins correlated significantly with values for fasting plasma glucose (r = 0.52, n = 17, p less than 0.05) in these patients and with mean glucose measurements in five diabetic patients who used home glucose monitoring (r = 0.91, p less than 0.05). Contrary to studies with ion-exchange chromatography, our measurements of glycated hemoglobin showed no positive correlation with concentrations of urea in serum. In a separate group of patients, we found that hemodialysis sessions produced no acute effect on glycated hemoglobin. Measurements of glycated hemoglobins by analytically specific methods may thus better reflect long-term control of blood glucose in renal dialysis.

Dapagliflozin does not show improvement in glycemic control in moderate renal impairment: a question of analytical rigor?

“…Finally, the reductions in HbA1c obtained in patients with stage 3 chronic kidney disease in this study are similar to those obtained with other members of the class of SGLT2 inhibitors. 3,4 The difference in our study is that the difference from placebo was not statistically significant, which is most likely attributable to the reduction in HbA1c also seen in the placebo group.…”

“…High-performance liquid chromatography using ion exchange to separate HbA1c is subjected to interference from carbamylated hemoglobin, addition of isocyanic acid derived from urea, which co-elutes with glycated hemoglobin due to its similar charge. 3 Affinity chromatography is not subjected to this interference; 3 however, the paper methodology gives no detail as to which technique was used. The paper also describes a 'colorimetric assay' for creatinine, which could apply to several methods.…”

“…The utility for screening for lung cancer in the general population is controversial. 3 As for kidney cancer, screening for kidney cancer in kidney transplant patients is not cost-effective. 4 Vigilance for symptoms and better cancer treatment will save lives, not surveillance programs.…”

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“…Exposure to high urea concentrations promotes formation of carbamylated hemoglobin, which cannot be distinguished from glycated hemoglobin in certain assays (e.g., electric charge‐based assays) . In contrast, boronate‐agarose affinity chromatography and thiobarbituric acid methods provide more robust measurement of HbA1c in dialysis patients .…”

Occupational arsenic exposure and glycosylated haemoglobin†

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