Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1053, USA.
Perit Dial Int. 2010 Jan-Feb;30(1):72-9. doi: 10.3747/pdi.2008.00243.
Relative to hemoglobin A(1c) (HbA(1c)), percentage of glycated albumin (GA%) more accurately reflects recent glycemic control in diabetic hemodialysis (HD) patients.
To determine the accuracy of glycemic assays in a larger sample including patients on peritoneal dialysis (PD), HbA(1c) and GA% were measured in 519 diabetic subjects: 55 on PD, 415 on HD, and 49 non-nephropathy controls.
Mean +/- SD serum glucose levels were higher in HD and PD patients relative to non-nephropathy controls (HD 169.7 +/- 62 mg/dL, PD 168.6 +/- 66 mg/dL, controls 146.1 +/- 66 mg/dL; p = 0.03 HD vs controls, p = 0.13 PD vs controls). GA% was also higher in HD and PD patients (HD 20.6% +/- 8.0%, PD 19.0% +/- 5.7%, controls 15.7% +/- 7.7%; p < 0.02 HD vs controls and PD vs controls). HbA(1c) was paradoxically lower in dialysis patients (HD 6.78% +/- 1.6%, PD 6.87% +/- 1.4%, controls 7.3% +/- 1.4%; p = 0.03 HD vs controls, p = 0.12 PD vs controls). The serum glucose/HbA(1c) ratio differed significantly between dialysis patients and controls (p < 0.0001 HD vs controls, p = 0.002 PD vs controls), while serum glucose/GA% ratio was similar across groups (p = 0.96 HD vs controls, p = 0.64 PD vs controls). In best-fit multivariate models with HbA(1c) or GA% as outcome variable, dialysis status was a significant predictor of HbA(1c) but not GA%.
The relationship between HbA(1c) and GA% differs in diabetic patients with end-stage renal disease who perform either PD or HD compared to those without nephropathy. HbA(1c) significantly underestimates glycemic control in peritoneal and hemodialysis patients relative to GA%.
与血红蛋白 A1c（HbA1c）相比，糖化白蛋白百分比（GA%）更能准确反映糖尿病血液透析（HD）患者的近期血糖控制情况。
为了在更大的样本中确定血糖检测的准确性，我们测量了 519 例糖尿病患者的 HbA1c 和 GA%：55 例接受腹膜透析（PD），415 例接受 HD，49 例非肾病对照组。
与非肾病对照组相比，HD 和 PD 患者的血清葡萄糖水平更高（HD 为 169.7±62mg/dL，PD 为 168.6±66mg/dL，对照组为 146.1±66mg/dL；p=0.03，HD 与对照组相比，p=0.13，PD 与对照组相比）。HD 和 PD 患者的 GA%也更高（HD 为 20.6%±8.0%，PD 为 19.0%±5.7%，对照组为 15.7%±7.7%；p<0.02，HD 与对照组和 PD 与对照组相比）。令人惊讶的是，透析患者的 HbA1c 反而较低（HD 为 6.78%±1.6%，PD 为 6.87%±1.4%，对照组为 7.3%±1.4%；p=0.03，HD 与对照组相比，p=0.12，PD 与对照组相比）。透析患者与对照组之间的血清葡萄糖/HbA1c 比值差异显著（p<0.0001，HD 与对照组相比，p=0.002，PD 与对照组相比），而血清葡萄糖/GA%比值在各组之间相似（p=0.96，HD 与对照组相比，p=0.64，PD 与对照组相比）。在以 HbA1c 或 GA%为因变量的最佳拟合多元模型中，透析状态是 HbA1c 的显著预测因素，但不是 GA%的预测因素。
与无肾病的患者相比，接受腹膜透析或血液透析的终末期肾病糖尿病患者的 HbA1c 与 GA%之间的关系不同。HbA1c 显著低估了腹膜透析和血液透析患者的血糖控制情况，而 GA%则相反。
