Chen Christina W, Drechsler Christiane, Suntharalingam Pirianthini, Karumanchi S Ananth, Wanner Christoph, Berg Anders H
Division of Nephrology and Center for Vascular Biology Research, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Division of Nephrology, Department of Internal Medicine 1, University Hospital Würzburg and Comprehensive Heart Failure Center, Würzburg, Germany.
Clin Chem. 2017 Feb;63(2):477-485. doi: 10.1373/clinchem.2016.258319. Epub 2016 Oct 13.
Monitoring of glycemic control with hemoglobin A (A1c) in hemodialysis patients may be compromised by anemia and erythropoietin therapy. Glycated albumin (GA) is an alternative measure of glycemic control but is not commonly used because of insufficient evidence of association to clinical outcomes. We tested whether GA measurements were associated with mortality in hemodialysis patients with diabetes mellitus.
The German Diabetes and Dialysis Study (4D) investigated effects of atorvastatin on survival in 1255 patients with diabetes mellitus receiving hemodialysis. We measured GA during months 0, 6, and 12. Cox proportional hazards analysis was used to measure associations between GA and A1c and all-cause mortality.
Patients with high baseline GA (fourth quartile) had a 42% higher 4-year mortality compared to those in the first quartile (HR 1.42; 95% CI, 1.09-1.85, P = 0.009). Repeated measurements of GA during year one also demonstrated that individuals in the top quartile for GA (analyzed as a time-varying covariate) had a 39% higher 4-year mortality (HR 1.39; 95% CI, 1.05-1.85, P = 0.022). The associations between high A1c and mortality using similar analyses were less consistent; mortality in individuals with baseline A1c values in the 3rd quartile was increased compared to 1st quartile (HR 1.36; 95% CI, 1.04-1.77, P = 0.023), but risk was not significantly increased in the 2nd or 4th quartiles, and there was a less consistent association between time-varying A1c values and mortality.
High GA measurements are consistently associated with increased mortality in patients with diabetes mellitus on hemodialysis.
在血液透析患者中，使用糖化血红蛋白（A1c）监测血糖控制情况可能会受到贫血和促红细胞生成素治疗的影响。糖化白蛋白（GA）是血糖控制的另一种测量指标，但由于其与临床结局的关联证据不足，并不常用。我们测试了GA测量值是否与糖尿病血液透析患者的死亡率相关。
德国糖尿病与透析研究（4D）调查了阿托伐他汀对1255例接受血液透析的糖尿病患者生存情况的影响。我们在第0、6和12个月测量了GA。采用Cox比例风险分析来测量GA与A1c以及全因死亡率之间的关联。
基线GA处于高值（第四四分位数）的患者与第一四分位数的患者相比，4年死亡率高42%（风险比1.42；95%置信区间，1.09 - 1.85，P = 0.009）。在第一年对GA进行重复测量也表明，GA处于最高四分位数的个体（作为时变协变量进行分析）4年死亡率高39%（风险比1.39；95%置信区间，1.05 - 1.85，P = 0.022）。使用类似分析得出的高A1c与死亡率之间的关联不太一致；与第一四分位数相比，基线A1c值处于第三四分位数的个体死亡率有所增加（风险比1.36；95%置信区间，1.04 - 1.77，P = 0.023），但在第二或第四四分位数中风险并未显著增加，并且时变A1c值与死亡率之间的关联不太一致。
高GA测量值与糖尿病血液透析患者死亡率增加始终相关。
