Usefulness of glycated albumin as a predictor of mortality in chronic hemodialysis patients with diabetes: a multi-center, prospective cohort study

Abstract

Background: The association of glycated albumin (GA) with mortality is unclear in chronic hemodialysis patients with diabetes. We investigated the usefulness of GA by comparing it with hemoglobin A1c (HbA1c) in this patient population. Research design and methods: This was a multi-center, prospective cohort study of 841 Japanese chronic hemodialysis patients with diabetes. There were 235 women and 606 men included, with a mean age of 64 years. The primary and secondary endpoints were the incidence of all-cause and cause-specific mortality, respectively. The hazard ratios of GA and HbA1c for the endpoints were estimated using the values at baseline and during the study period. Results: During the mean follow-up period of 3.1 years, there were 184 deceased cases, in which 30 and 154 resulted from atherosclerotic cardiovascular disease (ASCVD) and non-ASCVD, respectively. The hazard ratio for a 1% increase in GA was 1.033 (95% confidence interval 1.006-1.060, p = 0.017) for all-cause mortality with a statistical significance when GA was treated as a time dependent variable, but not when the baseline levels or the mean levels during the followup period were used in the analysis (p = 0.815 and 0.517, respectively). GA was a significant predictor for ASCVD-related mortality in the above 3 models, but was not for non-ASCVD mortality. Higher levels of HbA1c were only associated with ASCVD-related mortality when HbA1c was treated as a time-dependent variable.

Toward Revision of the ‘Best Practice for Diabetic Patients on Hemodialysis 2012’

“…These results suggest a need to set the target GA value for glycemic control based on consideration of such factors as the use of antidiabetic agents, nutritional status, and patient background, such as cancer development status. Furthermore, based on the multicenter prospective observational study of 841 chronic dialysis patients with diabetes for a mean study period of 3.1 years, GA levels could be a prognostic factor in predicting atherosclerotic cardiovascular disease (ASCVD)-related mortality [16]. Overall, it was suggested that GA might be a more suitable parameter than HbA1c for accurately predicting the prognosis of dialysis patients with diabetes.…”