We studied the influence of erythropoietin (EPO) treatment on hemoglobin Alc (HbAlc) levels under conditions which eliminate the effect of changes in the blood glucose concentration. HbAlc levels, blood glucose, hematocrit (Hct) and reticulocyte counts were serially measured every two weeks after starting or stopping EPOadministration in 15 non-diabetic hemodialysis patients. EPOtreatment significantly influenced HbAlc levels, and the more erythropoiesis fluctuated by changing the dose ofEPO, the more HbAlc levels changed, though there were no significant changes in blood glucose levels during the study period. The changes in HbAlc during the 2-week period correlated inversely with both the changes in Hct during the same 2 weeks and the reticulocyte counts at that time. Weconcluded that the change in Hct should be kept in mind when the HbAlc level is evaluated in EPO-treated patients and a formula should be proposed to correct HbAlc levels based on the change in Hct or the reticulocyte count. (Internal Medicine 37: 826-830, 1998)

Interstitial lesions but not glomerular lesions were a significant predictor for renal prognosis in diabetic nephropathy in type 2 diabetes patients with overt proteinuria.

Background and Objective The influence of glycemic control on cardiovascular (CV) complications or survival is not clear in diabetic patients with end-stage renal disease (ESRD

Despite concerns about the utility of HbA1c measurement in hemodialysis patients, high levels (≥ 8.5%) are associated with increased mortality risk. Very low HbA1c levels (≤ 5.4%) also may be associated with increased mortality risk.

Background Glycated albumin (GA), which is an alternative glycemic marker, is influenced by factors associated with albumin turnover, and it is not clear whether proteinuria influences GA values in diabetic patients with chronic kidney disease (CKD). Methods We enrolled 94 diabetic patients with CKD stages 3 to 5. GA, glycated hemoglobin, and urinary protein excretion (UP) levels were consecutively obtained in each patient. The correlations between GA and UP and those between changes in GA and UP were examined. Results There was a significant correlation between GA and UP in all cases (r=-0.46, p<0.0001), however no significant correlation was found in cases with UP of 0-3.49 g/day (r=0.01). GA values in cases with UP "3.5 g/day were significantly lower than those in cases with UP <3.5 g/day [UP "3.5 g/day and serum albumin (Alb) !3 g/dL; 12.0 ± 1.3%, UP "3.5 g/day and Alb >3 g/dL; 17.8 ± 4.3%, 0" UP <3.5 g/day; 21.2 ± 4.2%], while no significant difference in HbA1c or glucose levels was found. In cases with a minimum of UP "0.5 g/day, no significant correlation was found between the difference in GA and the difference in UP at the point of maximum UP and minimum UP (r=0.04). Conclusion Nephrotic-range proteinuria decreases GA values independent of the glycemic state, while nonnephrotic range proteinuria has no significant influence on GA values in diabetic CKD patients.