Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Appl Lab Med. 2022 Jun 30;7(4):842-853. doi: 10.1093/jalm/jfac006.
Glycated albumin may provide complementary information to hemoglobin A1c (HbA1c). We compared cross-sectional associations of HbA1c and glycated albumin with chronic kidney disease (CKD) in US adults.
We included 10 923 adults (9955 without diagnosed diabetes, 968 with a diabetes diagnosis) from the National Health and Nutrition Examination Survey 1999-2004. We examined continuous associations and clinical cut points for HbA1c among those without diabetes (<5.0%, 5.0%-5.6% (reference), 5.7%-6.4%, ≥6.5%) and among those with diagnosed diabetes (<7.0%, 7.0%-8.9%, ≥9.0%) and percentile equivalents for glycated albumin. We used logistic regression to compare associations with prevalent CKD, adjusting for traditional risk factors. We used likelihood ratio tests to assess whether adding glycated albumin improved the model with HbA1c.
There were J-shaped associations for both glycated albumin and HbA1c with CKD. Persons without a history of diabetes and very low glycated albumin or HbA1c were more likely to have CKD compared to those without diabetes and normoglycemia. The odds ratios (ORs) for CKD were 1.32 (95% CI, 1.12-1.55) for HbA1c 5.7% to 6.4% and 2.04 (95% CI, 1.28-3.25) for HbA1c ≥6.5%. The ORs for glycated albumin were 1.27 (95% CI, 1.06-1.51) and 2.48 (95% CI, 1.50-4.08) for glycated albumin 14.4% to 17.8% and ≥17.9%, respectively. The inclusion of glycated albumin in the model with HbA1c and traditional risk factors modestly but significantly improved the model fit (P value = 0.006).
Glycated albumin and HbA1c were similarly associated with prevalent CKD. Glycated albumin provides complementary information to HbA1c for prevalent CKD.
糖化白蛋白可能为血红蛋白 A1c（HbA1c）提供补充信息。我们比较了美国成年人中 HbA1c 和糖化白蛋白与慢性肾脏病（CKD）的横断面关联。
我们纳入了 1999-2004 年国家健康和营养调查（NHANES）中的 10923 名成年人（9955 名无糖尿病诊断，968 名糖尿病诊断）。我们在无糖尿病（<5.0%、5.0%-5.6%（参考值）、5.7%-6.4%、≥6.5%）和糖尿病诊断（<7.0%、7.0%-8.9%、≥9.0%）个体中检查了 HbA1c 的连续关联和临床切点，以及糖化白蛋白的百分位等效值。我们使用逻辑回归比较了与 CKD 患病率相关的指标，调整了传统危险因素。我们使用似然比检验评估了添加糖化白蛋白是否改善了 HbA1c 模型。
糖化白蛋白和 HbA1c 与 CKD 均呈 J 形关联。与无糖尿病且血糖正常的个体相比，无糖尿病且糖化白蛋白或 HbA1c 极低的个体更有可能患有 CKD。HbA1c 为 5.7%-6.4%和 HbA1c≥6.5%的 CKD 的比值比（ORs）分别为 1.32（95%CI，1.12-1.55）和 2.04（95%CI，1.28-3.25）。糖化白蛋白的 ORs 分别为 1.27（95%CI，1.06-1.51）和 2.48（95%CI，1.50-4.08），对于糖化白蛋白 14.4%-17.8%和≥17.9%。将糖化白蛋白纳入 HbA1c 和传统危险因素模型中，可适度但显著地改善模型拟合度（P 值=0.006）。
糖化白蛋白和 HbA1c 与 CKD 的患病率相似相关。糖化白蛋白为 HbA1c 提供了对 CKD 患病率的补充信息。
