A1c does not prove to be tell-tale of sugar control for dialysis patients
The standard A1c test is now said to underestimate true glucose control in dialysis patients which could lead to a very false sense of comfort. This came as a real shock for the over 200,000 diabetics that depend on hemodialysis and nephrology community alike.
This study evaluated 307 patients with diabetes — 258 with end-stage kidney disease on hemodialysis and 49 who did not have kidney failure. The researchers compared the standard HbA1c test with a newer test (glycated albumin, or GA) that measures the amount of blood sugar that has reacted with albumin, a protein in the plasma. The GA test reflects blood sugar control over the previous three to four weeks. Blood samples were also analyzed to determine recent blood sugar levels.
Among the 307 patients with diabetes, 258 in end-staged kidney disease on dialysis and 49 who did not have kidney failure, the researchers found that the HbA1c values were considerably lower in comparison to the GA test results. Scary indeed.
The thought process on the marginal difference is that the red blod cells do not live as long in hemodialysis patients than the normal population. Most dialysis patients have anemia requiring treatment with medications that stimulate red blood cell production (erythropoietin).
The GA test is not currently available in the United States. Freedman said that until it is available, doctors and patients should be aware that the HbA1c underestimates glucose control and is affected by both erythropoietin administration and the hemoglobin concentration.
via Wake Forest University Baptist Medical Center
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