Correlation between glycated hemoglobin and mean plasma glucose in hemodialysis patients

Department of Internal Medicine, Nephrology Division, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, USA.
International Urology and Nephrology (Impact Factor: 1.52). 12/2011; 43(4):1149-53. DOI: 10.1007/s11255-010-9800-1
Source: PubMed


Since the half-life of red blood cells (RBCs) is shorter in hemodialysis patients, the value of glycated hemoglobin (HbA1c) as a marker of glycemic control in patients with diabetes on hemodialysis has recently been questioned. It is thought that it is not a good marker of mean plasma glucose (MPG) over a 3-month duration. In our current study, we evaluate whether monthly HbA1c values is a better marker of glycemic control than HbA1c every 3 months.
We performed a cross-sectional analysis of a retrospective cohort of 152 patients with diabetes who presented to two hemodialysis units in NYC. Patients had weekly predialysis glucose levels checked over the last 3 months, and HbA1c values were checked every 3 months. Data collection spanned a 6-month time frame from August 2008 to January 2009.
We found no difference in the correlation between HBA1c/mean plasma glucose (MPG) over the last month (MPG1m) and HbA1c/mean plasma glucose (MPG) over the last 3 months (MPG3m; r = 0.57 and r = 0.53, respectively; P = 0.212). Using multivariate analysis, reticulocyte count and weekly erythropoietin dose were found to independently and inversely effect the correlations HbA1c/MPG1m and HbA1c/MPG3m.
The value of HbA1c in hemodialysis for monitoring glycemic control is limited in the setting of a high reticulocyte count (>2%) and a high weekly erythropoietin dose. Checking HbA1c monthly versus every 3 months is not a better approximation of glycemic control in hemodialysis patients.

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    ABSTRACT: Within in the scope of this study, a research was aimed at the relationship between HbA1c markers and blood glucose levels with DM, chronic renal failure and receiving dialysis treatment. In this study, monthly glucose levels and quarterly HbA1c markers of 131 patients (53 female, 78 male) receiving dialysis treatment in a private dialysis center between January 1, 2009-July 31, 2010 were evaluated retrospectively. The average age of 131 cases was 63.3±11.2 years (range, 30-91). Gender distribution of the cases: 53 female (40.5%), 78 male (59.5%). While the age average of the females was 62.2±11.2 and the males' was 64.1±11.2. The average glucose level of the females and males have a correlation to average HbA1c (Female: p<0.001, r=0.761, Males: p<0.001, r=0.743). The average glucose level of the both case groups have a correlation to average HbA1c (p<0.001, r=0.755). While 32.8% of the examined HbA1c results were observed under the level 6,5%, and 67.2% of the examined results were observed above the level 6.5%. While 18.3% of the pre-prandial blood glucose levels were obtained under 126 mg/dl level, and 81.3% of the results were obtained above 126 mg/dl level. It has been observed that the mean blood glucose level has a correlation to average HbA1c level. The measurement of HbA1c and blood glucose (pre-prandial and postprandial) and the correlation between them, by virtue of the fact that, are vitally important in cardiovascular mortality and morbidity, monitor of DM for the dialysis patients with diabetic nephropathy.