Williams Mark E, Mittman Neal, Ma Lin, Brennan Julia I, Mooney Ann, Johnson Curtis D, Jani Chinu M, Maddux Franklin W, Lacson Eduardo
Renal Unit, Joslin Diabetes Center, Boston, Massachusetts, USA.
Department of Dialysis, Kidney Care of Brooklyn and Queens, Brooklyn, New York, USA.
Hemodial Int. 2015 Oct;19(4):562-71. doi: 10.1111/hdi.12312. Epub 2015 May 12.
The validity of hemoglobin A1c (HgbA1c) is undergoing increasing scrutiny in the advanced CKD/ESRD (chronic kidney disease/end-stage renal disease) population, where it appears to be discordant from other glycemic indices. In the Glycemic Indices in Dialysis Evaluation (GIDE) Study, we sought to assess correlation of HgbA1c with casual glucose, glycated albumin, and serum fructosamine in a large group of diabetic patients on dialysis. From 26 dialysis facilities in the United States, 1758 diabetic patients (hemodialysis = 1476, peritoneal dialysis = 282) were enrolled in the first quarter of 2013. The distributions of HgbA1c and the other glycemic indices were analyzed. Intra-patient coefficients of variation and correlations among the four glycemic indices were determined. Patients with low HgbA1c values were both on higher erythropoietin (ESA) doses and more anemic. Serum glucose exhibited the highest intra-patient variability over a 3-month period; variability was modest among the other glycemic indices, and least with HgbA1c. Statistical analyses inclusive of all glycemic markers indicated modest to strong correlations. HgbA1c was more likely to be in the target range than glycated albumin or serum fructosamine, suggesting factors which may or may not be directly related to glycemic control, including anemia, ESA management, and iron administration, in interpreting HgbA1c values. These initial results from the GIDE Study clarify laboratory correlations among glycemic indices and add to concerns about reliance on HgbA1c in patients with diabetes and advanced kidney disease.
血红蛋白A1c（HgbA1c）在晚期慢性肾脏病/终末期肾病（CKD/ESRD）人群中的有效性正受到越来越多的审视，在这一人群中，HgbA1c似乎与其他血糖指标不一致。在透析评估中的血糖指标（GIDE）研究中，我们试图评估一大群接受透析的糖尿病患者中HgbA1c与随机血糖、糖化白蛋白和血清果糖胺之间的相关性。2013年第一季度，从美国26个透析机构招募了1758例糖尿病患者（血液透析 = 1476例，腹膜透析 = 282例）。分析了HgbA1c和其他血糖指标的分布情况。确定了患者内四个血糖指标的变异系数和相关性。HgbA1c值较低的患者促红细胞生成素（ESA）剂量较高且贫血更严重。血清葡萄糖在3个月期间表现出最高的患者内变异性；其他血糖指标的变异性适中，HgbA1c的变异性最小。包括所有血糖标志物的统计分析表明存在中度至强相关性。与糖化白蛋白或血清果糖胺相比，HgbA1c更有可能处于目标范围内，这表明在解释HgbA1c值时，可能与血糖控制直接相关或不直接相关的因素，包括贫血、ESA管理和铁剂给药。GIDE研究的这些初步结果阐明了血糖指标之间的实验室相关性，并增加了对糖尿病和晚期肾病患者依赖HgbA1c的担忧。
