Glycated albumin is a more accurate glycaemic indicator than haemoglobin A1c in diabetic patients with pre-dialysis chronic kidney disease

Abstract

Aim Glycated albumin (GA) has been reported to be a more reliable glycaemic indicator than haemoglobin A1c (HbA1c) in patients with diabetes on dialysis. However, the significance of these assays has been less evaluated in patients with diabetes and pre-dialysis chronic kidney disease (CKD). Methods GA, HbA1c and fasting serum glucose were measured simultaneously in 146 patients with diabetes. Based on estimated glomerular filtration rate (eGFR), the subjects were categorized into a pre-dialysis CKD group (eGFR < 60 mL/min per 1.73 m2, n = 97) and a non-CKD group (eGFR ≥ 60 mL/min per 1.73 m2, n = 49). Results The glucose/HbA1c and GA/HbA1c ratios were significantly higher in the CKD group than those in the non-CKD group. The glucose/GA ratio did not differ significantly between the two groups. In the pre-dialysis CKD group, eGFR was negatively correlated with the glucose/HbA1c ratio (r = -0.343, P = 0.001) and the GA/HbA1c ratio (r = -0.499, P < 0.001). However, no significant correlation was detected between eGFR and the glucose/GA ratio. In the non-CKD group, eGFR was not correlated with the glucose/HbA1c ratio, the glucose/GA ratio, or the GA/HbA1c ratio. A multivariate regression analysis showed that eGFR had a significant impact on HbA1c but no effect on GA in the pre-dialysis CKD group (β = 0.210, P = 0.005). In the non-CKD group, eGFR did not affect HbA1c or GA. Conclusion Our results show that HbA1c significantly underestimated glycaemic control, whereas GA more accurately reflected glycaemic control in diabetic patients with pre-dialysis CKD.