Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy. 13(2)
In hemodialysis (HD) patients the glycated hemoglobin (Hb(A1c)) level may underestimate glycemic control. The aim of this study is to estimate accurate glycemic control in type 2 diabetic patients on HD. Type 2 diabetes patients (N = 87) who had been receiving maintenance HD for at least one year were enrolled. Hb(A1c) and the percentage of glycated albumin relative to total the serum albumin (%GA) were measured in blood samples and the factors that affected the %GA/Hb(A1c) ratio were examined. There were significant and positive correlations between the plasma glucose and either the Hb(A1c) levels (r = 0.539, P0.01) or the %GA level (r = 0.520, P0.01). No relationship between the serum albumin levels and %GA levels was observed. A weekly dose of erythropoietin (EPO) was positively correlated with the ratio of %GA/Hb(A1c) and hematocrit (Ht) correlated negatively. There was no significant correlation between the %GA/Hb(A1c) level and the EPO dose in patients with Htor = 30%, although a significant correlation was found between those parameters in the Ht30% group. The mean of the %GA/Hb(A1c) ratios in patients with Htor = 30%, with Ht30% and treated with EPO100 IU/kg/week, and with Ht30% and treated with EPOor = 100 IU/kg/week were 3.41, 3.56 and 4.13, respectively. In HD patients, accurate glycemic control may be estimated as: Hb(A1c) x 1.14 if Htor = 30%; Hb(A1c) x 1.19 if Ht30% and treated with low dosages of EPO; and Hb(A1c) x 1.38 if Ht30% and treated with high dosages of EPO.