Lu Chien-Lin, Ma Wen-Ya, Lin Yuh-Feng, Shyu Jia-Fwu, Wang Yuan-Hung, Liu Yueh-Min, Wu Chia-Chao, Lu Kuo-Cheng
1. Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.; 2. Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
2. Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
Int J Med Sci. 2016 May 10;13(5):395-402. doi: 10.7150/ijms.14259. eCollection 2016.
In patients with advanced renal dysfunction undergoing maintenance hemodialysis, glycated albumin (GA) levels may be more representative of blood glucose levels than hemoglobin A1C levels. The aim of this study was to determine the predictive power of GA levels on long-term survival in hemodialysis patients.
A total of 176 patients with a mean age of 68.2 years were enrolled. The median duration of follow-up was 51.0 months. Receiver-operating characteristic curve analysis was utilized to determine the optimal cutoff value. We examined the cumulative survival rate by Kaplan-Meier estimates and the influence of known survival factors with the multivariate Cox proportional-hazard regression model.
In the whole patient group, cumulative survival in the low GA group was better than in the high GA group (p=0.030), with more prominence in those aged <70 years (p=0.029). In subgroup analysis, both diabetic (DM) and non-DM patients with low GA had a better cumulative survival compared with those with high GA. The risk of mortality increased by 3.0% for each 1% increase in serum GA level in all patients undergoing hemodialysis.
In addition to serving as a glycemic control marker, GA levels may be useful for evaluating the risk of death in both DM and non-DM patients on hemodialysis.
在接受维持性血液透析的晚期肾功能不全患者中，糖化白蛋白（GA）水平可能比糖化血红蛋白A1C水平更能代表血糖水平。本研究的目的是确定GA水平对血液透析患者长期生存的预测能力。
共纳入176例平均年龄为68.2岁的患者。中位随访时间为51.0个月。采用受试者操作特征曲线分析来确定最佳临界值。我们通过Kaplan-Meier估计法检查累积生存率，并使用多变量Cox比例风险回归模型分析已知生存因素的影响。
在整个患者组中，低GA组的累积生存率高于高GA组（p=0.030），在年龄<70岁的患者中更为显著（p=0.029）。在亚组分析中，低GA的糖尿病（DM）和非DM患者的累积生存率均高于高GA患者。在所有接受血液透析的患者中，血清GA水平每升高1%，死亡风险增加3.0%。
除了作为血糖控制指标外，GA水平可能有助于评估血液透析的DM和非DM患者的死亡风险。
