Yajima Takahiro, Yajima Kumiko, Hayashi Makoto, Yasuda Keigo, Takahashi Hiroshi, Yamakita Noriyoshi
Department of Nephrology, Matsunami General Hospital, Gifu 501-6062, Japan.
Department of Internal Medicine, Matsunami General Hospital, Gifu 501-6062, Japan.
J Diabetes Complications. 2016 Jul;30(5):786-9. doi: 10.1016/j.jdiacomp.2016.02.021. Epub 2016 Mar 2.
Glycated albumin (GA) is a marker for monitoring glycemic control in diabetic patients with end-stage renal disease (ESRD). We evaluated whether serum albumin-adjusted GA (adjusted GA) could predict mortality in diabetic patients with ESRD on hemodialysis.
Seventy-eight patients with type 2 diabetes treated with regular hemodialysis were enrolled and followed up for 5-years. The adjusted GA was calculated from the regression formula and mean GA. The cut-off values for GA and adjusted GA that predicted mortality risk were determined using receiver operating characteristic curve analysis.
During the follow-up period (median: 36months), 15 patients died. In the Kaplan-Meier analysis, there were no significant differences in the 5-year cumulative survival rate (58.3% [GA ≥19.8%] vs. 88.6% [GA <19.8%], P=0.075). Conversely, this rate was significantly higher in patients with adjusted GA <21.2% than adjusted GA ≥21.2% (86.4 vs. 49.5%, P=0.0068). After adjustment for other confounders, adjusted GA ≥21.2% was an independent predictor for mortality (hazard ratio 3.76, 95% confidence interval 1.12-17.44, P=0.031), but GA ≥19.8% was not (hazard ratio 2.63, 95% confidence interval 0.65-17.69, P=0.19).
Adjusted GA is a better predictor of mortality than GA in diabetic patients with ESRD on hemodialysis.
糖化白蛋白（GA）是监测终末期肾病（ESRD）糖尿病患者血糖控制的一个指标。我们评估了血清白蛋白校正的GA（校正GA）是否能预测接受血液透析的ESRD糖尿病患者的死亡率。
纳入78例接受规律血液透析的2型糖尿病患者，并进行了5年的随访。校正GA由回归公式和平均GA计算得出。使用受试者工作特征曲线分析确定预测死亡风险的GA和校正GA的临界值。
在随访期间（中位数：36个月），15例患者死亡。在Kaplan-Meier分析中，5年累积生存率无显著差异（GA≥19.8%组为58.3%，GA<19.8%组为88.6%，P=0.075）。相反，校正GA<21.2%的患者这一比率显著高于校正GA≥21.2%的患者（86.4%对49.5%，P=0.0068）。在对其他混杂因素进行校正后，校正GA≥21.2%是死亡率的独立预测因素（风险比3.76，95%置信区间1.12-17.44，P=0.031），但GA≥19.8%不是（风险比2.63，95%置信区间0.65-17.69，P=0.19）。
对于接受血液透析的ESRD糖尿病患者，校正GA比GA能更好地预测死亡率。
