Shipman Kate E, Jawad Mohammed, Sullivan Katie M, Ford Clare, Gama Rousseau
New Cross Hospital, Clinical Chemistry, Wolverhampton WV10 0QP, United Kingdom.
New Cross Hospital, Clinical Chemistry, Wolverhampton WV10 0QP, United Kingdom.
Prim Care Diabetes. 2015 Apr;9(2):142-6. doi: 10.1016/j.pcd.2014.05.001. Epub 2014 Jun 2.
Glycated haemoglobin (A1C) has been recommended for the diagnosis of type 2 diabetes mellitus. Chronic kidney disease (CKD) is reported to increase A1C. The prevalence of CKD and its association with A1C as a diagnostic test for type 2 diabetes screening in a community population was studied.
Age, gender, ethnicity (white/South Asian), haemoglobin, A1C, fasting glucose and fructosamine were compared in participants with estimated glomerular filtration rate (eGFR) 30-59 (CKD 3) and ≥60 ml/min/1.73 m(2) using chi-squared or t-tests. Multivariable linear regression analyses were performed with A1C as the dependent variable; remaining variables were forced into a model to identify correlates with A1C. Data were parametric and expressed as means.
Of 949 participants 83.7% had eGFR ≥60, 16.3% had CKD 3 and only 2 had eGFR <30 (CKD ≥4). Compared with eGFR ≥60, patients with CKD 3 were older [p<0.001], had higher A1C [6.0% vs. 5.8%, p<0.001], fasting glucose [5.4 vs. 5.2m mol/L, p=0.003] and fructosamine [233.7 vs. 225.8μ mol/L, p<0.001] but lower haemoglobin [p=0.006]. After adjustment, gender and CKD stage were not associated with A1C. A1C was associated (p<0.05) positively with age, South Asian ethnicity, fasting glucose and fructosamine and inversely with haemoglobin levels.
Severe CKD (stage ≥4) is rare in primary care patients being screened for type 2 diabetes and its impact on A1C could not be evaluated. Although A1C is higher among patients with CKD stage 3 compared to those with eGFR ≥60, this appeared to be due to the confounding effect of other variables rather than the presence of CKD.
糖化血红蛋白（A1C）已被推荐用于2型糖尿病的诊断。据报道，慢性肾脏病（CKD）会使A1C升高。本研究旨在探讨社区人群中CKD的患病率及其与A1C作为2型糖尿病筛查诊断指标之间的关联。
采用卡方检验或t检验，比较估计肾小球滤过率（eGFR）为30 - 59（CKD 3期）和≥60 ml/min/1.73 m²的参与者的年龄、性别、种族（白人/南亚人）、血红蛋白、A1C、空腹血糖和果糖胺。以A1C为因变量进行多变量线性回归分析；将其余变量强制纳入模型以确定与A1C相关的因素。数据呈正态分布，以均值表示。
在949名参与者中，83.7%的人eGFR≥60，16.3%的人处于CKD 3期，只有2人eGFR＜30（CKD≥4期）。与eGFR≥60的患者相比，CKD 3期患者年龄更大[p＜0.001]，A1C更高[6.0%对5.8%，p＜0.001]，空腹血糖更高[5.4对5.2 mmol/L，p = 0.003]，果糖胺更高[233.7对225.8 μmol/L，p＜0.001]，但血红蛋白更低[p = 0.006]。调整后，性别和CKD分期与A1C无关。A1C与年龄、南亚种族、空腹血糖和果糖胺呈正相关（p＜0.05），与血红蛋白水平呈负相关。
在接受2型糖尿病筛查的初级保健患者中，重度CKD（≥4期）很少见，其对A1C的影响无法评估。尽管CKD 3期患者的A1C高于eGFR≥60的患者，但这似乎是由于其他变量的混杂效应而非CKD的存在所致。
