Superiority of glycated albumin over glycated haemoglobin as indicator of glycaemic control and predictor of all-cause mortality in patients with type 2 diabetes mellitus receiving peritoneal dialysis

Abstract

Background Glycated albumin, in contrast to glycated haemoglobin, precisely reflects glycaemic control and predicts all-cause mortality in haemodialysis patients with diabetes mellitus. However, whether those associations exist in diabetes mellitus patients receiving peritoneal dialysis remains unclear. Methods This was a retrospective cross-sectional and longitudinal observational study. We measured glycated albumin, glycated haemoglobin and casual plasma glucose for two months in diabetes mellitus-peritoneal dialysis ( n = 44) and diabetes mellitus-haemodialysis ( n = 88) patients (age-, gender-matched). The diabetes mellitus-peritoneal dialysis patients were followed for three years to monitor occurrence of all-cause mortality. Results Glycated albumin and glycated albumin/casual plasma glucose ratios, but not casual plasma glucose, glycated haemoglobin, or glycated haemoglobin/casual plasma glucose, were significantly lower in the diabetes mellitus-peritoneal dialysis as compared with the diabetes mellitus-haemodialysis patients. The regression lines between casual plasma glucose and glycated albumin showed a significant parallel shift downwards in diabetes mellitus-peritoneal dialysis as compared with diabetes mellitus-haemodialysis patients, while the slope did not differ significantly between the groups, resulting in underestimation of glycaemic control by 4.5%. Kapan-Meier analysis of the diabetes mellitus-peritoneal dialysis patients revealed that higher glycated albumin (median >18.0%), but not glycated haemoglobin (median >6.6%), indicated significantly elevated risk for all-cause mortality, which occurred in 15 patients (34.1%), as compared with those with a lower glycated albumin concentration. Higher glycated albumin concentration was also significantly and independently associated with all-cause mortality in multivariate Cox proportional hazards analysis. Conclusions Glycated albumin, in contrast to glycated haemoglobin, more precisely reflects glycaemic control in diabetes mellitus-peritoneal dialysis patients, based on its significant association with all-cause mortality. Furthermore, adjustment of the true glycated albumin concentration by adding 4.5% might provide a more precise measurement for determining glycaemic control in such patients.

Xanthine Oxidoreductase Inhibitor Use Associated With Reduced Risk of Sarcopenia and Severe Sarcopenia in Patients Undergoing Hemodialysis

“…Past history of cerebrovascular disease was defined as prior occurrence of ischemic stroke, transient ischemic attack, intracerebral hemorrhage, and/or subarachnoid hemorrhage. Blood samples were collected from each patient before the start of the first HD session of the week, with standard laboratory parameters including serum albumin, C-reactive protein (CRP), and uric acid levels analyzed using a routine laboratory method at the hospital ( 24 ).…”

Nutritional Status Association With Sarcopenia in Patients Undergoing Maintenance Hemodialysis Assessed by Nutritional Risk Index

“…Diabetes mellitus was defined based on the American Diabetes Association criteria or treatment for diabetes mellitus (22). Past history of cerebrovascular disease was defined as prior occurrence of intracerebral hemorrhage, transient ischemic attack, subarachnoid hemorrhage, and/or ischemic stroke (23,24).…”

“…The level of albumin in serum was analyzed using a bromocresol purple method, while that of the serum standard (low-sensitive) Creactive protein (CRP) was analyzed using a latex agglutination immunoassay (reference range; 0-4.5 mg/L) at the hospital. Other standard laboratory parameters including levels of total cholesterol, creatinine, and hemoglobin were analyzed by use of a routine laboratory method at the hospital (23,24).…”

Association of type 2 diabetes with periodontitis and tooth loss in patients undergoing hemodialysis

“…Because of the increases in the percentage of juvenile erythrocytes due to the effects of shortened erythroid lifespan, renal anemia, and the administration of erythropoiesis-stimulating agents, HbA1c is lower than the actual level of glycemic control in hemodialysis patients, and glycoalbumin reflects the glycemic control more precisely than does HbA1c [31,32]. Therefore, the association of the number of missing teeth with glycoalbumin that we identified herein indicates that poor glycemic control may be related to increased tooth loss in hemodialysis patients with T2D.…”