Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,
Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Nephron. 2021;145(1):14-19. doi: 10.1159/000511614. Epub 2020 Dec 2.
Glycated haemoglobin A1c (HbA1c) has limitations as a glycemic marker for patients with diabetes and CKD and for those receiving dialysis. Glycated albumin is an alternative glycemic marker, and some studies have found that glycated albumin more accurately reflects glycemic control than HbA1c in these groups. However, several factors are known to influence the value of glycated albumin including proteinuria. Continuous glucose monitoring (CGM) is another alternative to HbA1c. CGM allows one to assess mean glucose, glucose variability, and the time spent in hypo-, normo-, and hyperglycemia. Currently, several different CGM models are approved for use in patients receiving dialysis; CKD (not on dialysis) is not a contraindication in any of these models. Some devices are for blind recording, while others provide real-time data to patients. Small studies suggest that CGM could improve glycemic control in hemodialysis patients, but this has not been studied for individual CKD stages.
Glycated albumin and CGM avoid the pitfalls of HbA1c in CKD and dialysis populations. However, the value of glycated albumin may be affected by several factors. CGM provides a precise estimation of the mean glucose. Here, we discuss the strengths and limitations for using HbA1c, glycated albumin, or CGM in CKD and dialysis population. Key Messages: Glycated albumin is an alternative glycemic marker but is affected by proteinuria. CGM provides a precise estimation of mean glucose and glucose variability. It remains unclear if CGM improves glycemic control in the CKD and dialysis populations.
糖化血红蛋白（HbA1c）作为糖尿病和 CKD 患者以及接受透析治疗患者的血糖标志物存在局限性。糖化白蛋白是一种替代的血糖标志物，一些研究发现，在这些人群中，糖化白蛋白比 HbA1c 更能准确反映血糖控制情况。然而，有几个已知的因素会影响糖化白蛋白的数值，包括蛋白尿。连续血糖监测（CGM）是 HbA1c 的另一种替代方法。CGM 可评估平均血糖、血糖变异性以及低血糖、正常血糖和高血糖的时间。目前，有几种不同的 CGM 模型已获准在接受透析治疗的患者中使用；在这些模型中，CKD（未接受透析治疗）不是禁忌症。一些设备用于盲录，而其他设备则向患者提供实时数据。一些小型研究表明，CGM 可以改善血液透析患者的血糖控制情况，但尚未针对 CKD 的各个阶段进行研究。
糖化白蛋白和 CGM 避免了 HbA1c 在 CKD 和透析人群中的缺陷。然而，糖化白蛋白的价值可能受到几个因素的影响。CGM 可以精确估计平均血糖。在这里，我们讨论了在 CKD 和透析人群中使用 HbA1c、糖化白蛋白或 CGM 的优缺点。要点：糖化白蛋白是一种替代的血糖标志物，但会受到蛋白尿的影响。CGM 可精确估计平均血糖和血糖变异性。目前尚不清楚 CGM 是否能改善 CKD 和透析人群的血糖控制情况。
