Department of Internal Medicine-Nephrology, Wake Forest School of Medicine, Winston-Salem, NC 27157-1053, USA.
Clin J Am Soc Nephrol. 2011 Jul;6(7):1635-43. doi: 10.2215/CJN.11491210. Epub 2011 May 19.
Relative to hemoglobin (Hb) A(₁c), glycated albumin (GA) more accurately reflects glycemic control in patients with diabetes mellitus and ESRD. We determined the association between GA, HbA(₁c), and glucose levels with survival and hospitalizations in diabetic dialysis patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Quarterly GA levels were measured for up to 2.33 years in 444 prevalent patients with diabetes and ESRD. Proportional hazard time-dependent covariate models were computed with adjustment for demographic characteristics, comorbidities, and laboratory variables. Similar analyses were performed for available HbA(₁c) and monthly random serum glucose determinations.
The participants were 53% male, 54% African American, 43% Caucasian, 90% on hemodialysis, with a mean (SD) age of 62 (12) years and median follow-up duration of 2.25 years. GA and HbA(₁c) mean ± SD 21.5% ± 6.0%, median 20.4% and mean ± SD 6.9% ± 6.6%, median 1.6%, respectively. There were 156 deaths during the observation period. In best-fit models, predictors of death included increasing GA, increasing age, presence of peripheral vascular disease, decreasing serum albumin, and decreasing hemoglobin concentrations. HbA(1c) and random serum glucose concentrations were not predictive of survival. Increasing GA levels were associated with hospitalization in the 17 days after measurement, whereas HbA(₁c) was not.
In contrast to the HbA(₁c) and random serum glucose values, GA accurately predicts the risk of death and hospitalizations in patients with diabetes mellitus and ESRD. The GA assay should be considered by clinicians who care for patients with diabetes on dialysis.
与血红蛋白（Hb）A₁c 相比，糖化白蛋白（GA）更能准确反映糖尿病和终末期肾病（ESRD）患者的血糖控制情况。我们确定了 GA、HbA₁c 和血糖水平与糖尿病透析患者的生存和住院之间的关系。
设计、设置、参与者和测量方法：在 444 例患有糖尿病和 ESRD 的患者中，每季度测量一次 GA 水平，最长可达 2.33 年。使用比例风险时间依赖性协变量模型进行计算，并调整了人口统计学特征、合并症和实验室变量。对 HbA₁c 和每月随机血清葡萄糖测定进行了类似的分析。
参与者中 53%为男性，54%为非裔美国人，43%为白种人，90%接受血液透析，平均（SD）年龄为 62（12）岁，中位随访时间为 2.25 年。GA 和 HbA₁c 的平均值±SD 分别为 21.5%±6.0%和中位数 20.4%，平均值±SD 分别为 6.9%±6.6%和中位数 1.6%。在观察期间有 156 人死亡。在最佳拟合模型中，死亡的预测因素包括 GA 升高、年龄增加、周围血管疾病、血清白蛋白降低和血红蛋白浓度降低。HbA₁c 和随机血清葡萄糖浓度不能预测生存。GA 水平升高与测量后 17 天的住院有关，而 HbA₁c 则没有。
与 HbA₁c 和随机血清葡萄糖值相比，GA 能准确预测糖尿病和 ESRD 患者的死亡和住院风险。接受透析治疗的糖尿病患者的临床医生应考虑使用 GA 检测。
