How does CKD affect HbA1c?

Bloomgarden, Zachary T.; Handelsman, Yehuda

doi:10.1111/1753-0407.12624

Cited by 25 publications

(25 citation statements)

References 5 publications

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“…Several reports have suggested that alteration of HbA1c levels can be affected by several common factors, including erythrocyte turnover, iron deficiency, and kidney failure (27)(28)(29). In the present study, the negative association was maintained after making allowance for all possible confounders.…”

Section: Discussionsupporting

confidence: 62%

Influence of serum albumin on HbA1c and HbA1c-defined glycemic status: a retrospective study

Feng

Yang

Zhuang

et al. 2020

Preprint

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Backgound: Glycated hemoglobin (HbA1c) is commonly used in the diagnosis and evaluation of glycemic control in diabetes, and may be influenced by several non-glycemic and glycemic factors, including albumin. This retrospective study investigated the influence of albumin on HbA1c and HbA1c-defined glycemic status. Methods: The demographic, hematological, and biochemical data were collected for 11,922 patients undergoing routine physical examination. Univariate and multivariate linear regression analyses, stratified analyses and interaction analyses, and multiple logistic regression were conducted to identify the association between albumin and HbA1c in people with different glycemic status. Results: HbA1c levels were inversely associated with serum albumin level ( P < 0.0001) in all participants. Risk factors leading to the association included age >45 years, high fasting plasma glucose (≥7.0 mmol/L), and anemia. The negative association between HbA1c and albumin was curved ( P < 0.0001) and had a threshold effect in the HbA1c-defined diabetic population; the association was significantly stronger when the albumin level fell below 41.4 g/L (β: –0.31, 95% CI: –0.45 to –0.17, P < 0.0001). A 2 g/L increase in albumin reduced the odds of HbA1c-defined dysglycemia, diabetes, and poor glycemia control by 12% to 36%, after adjustment for all possible confounders. Conclusions: HbA1c was inversely associated with albumin level in all participants, and the association was significantly stronger in people with diabetes (defined by HbA1c criteria). For diabetic patients with lower albumin level, there was an increased risk of an erroneous HbA1c-based identification and management of glycemic status.

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Section: Discussionsupporting

confidence: 62%

Influence of serum albumin on HbA1c and HbA1c-defined glycemic status: a retrospective study

Feng

Yang

Zhuang

et al. 2020

Preprint

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“…≥65 years or with a Charlson comorbidity index scores ≥5 were excluded (Charlson et al, 1987;Bannay et al, 2016), considering that less stringent HbA1C goals (such as 8-8.5%) have been recommended for patients with limited life expectancy, extensive comorbid conditions, or frail, older adults since late 2000s (American Diabetes Association, 2021;American Diabetes Association, 2021). Patients with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m 2 were also excluded as this may have affected the HbA1c level and not accurately reflect the true glycemic status (Bloomgarden & Handelsman, 2018). In the end, 4282 eligible patients with ≥ 1 year of analytical data were included ( Fig.…”

Section: Subjectsmentioning

confidence: 99%

Predictors of treatment failure during the first year in newly diagnosed type 2 diabetes patients: a retrospective, observational study

Sia

Kor

et al. 2021

PeerJ

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Background Diabetes patients who fail to achieve early glycemic control may increase the future risk of complications and mortality. The aim of the study was to identify factors that predict treatment failure (TF) during the first year in adults with newly diagnosed type 2 diabetes mellitus (T2DM). Methods This retrospective cohort study conducted at a medical center in Taiwan enrolled 4,282 eligible patients with newly diagnosed T2DM between 2002 and 2017. Data were collected from electronic medical records. TF was defined as the HbA1c value >7% at the end of 1-year observation. A subgroup analysis of 2,392 patients with baseline HbA1c ≥8% was performed. Multivariable logistic regression analysis using backward elimination was applied to establish prediction models. Results Of all study participants, 1,439 (33.6%) were classified as TF during the first year. For every 1% increase in baseline HbA1c, the risk of TF was 1.17 (95% CI 1.15–1.20) times higher. Patients with baseline HbA1c ≥8% had a higher rate of TF than those with HbA1c <8% (42.0 vs 23.0%, p < 0.001). Medication adherence, self-monitoring of blood glucose (SMBG), regular exercise, gender (men), non-insulin treatment, and enrollment during 2010–2017 predicted a significant lower risk of TF in both of the primary and subgroup models. Conclusions Newly diagnosed diabetes patients with baseline HbA1c ≥8% did have a much higher rate of TF during the first year. Subgroup analysis for them highlights the important predictors of TF, including medication adherence, performing SMBG, regular exercise, and gender, in achieving glycemic control.

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“…Two reasons might explain this phenomenon. First, with the deterioration of renal function, the correlation between HbA1c and FPG is weakened, which is more obvious in patients with anemia [29]. HbA1c cannot accurately re ect recent blood glucose control in such situation.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of And Risk Factors for Normoalbuminuric Diabetic Kidney Disease In Hospitalized Patients With Type 2 Diabetes Mellitus: A Retrospective Cross-Sectional Study

Dai¹,

Chen²,

Ling³

et al. 2021

Preprint

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Background: Normoalbuminuric diabetic kidney disease (NADKD) is a newly defined DKD, the clinical features and pathogenesis for which are still being understood. This study aimed to investigate the features and risk factors for NADKD in patients with type 2 diabetes mellitus (T2DM).Methods: A retrospective cross-sectional study was conducted. The related clinical and laboratory data of patients with T2DM hospitalized between August 2012 and January 2020 were collected for statistical analysis. We classified the patients with T2DM into four groups on the basis of the presence or absence of albuminuria and reduced estimated glomerular filtration rate (eGFR). Analysis of variance, the Kruskal–Wallis test, and the chi-square test were used to compare the groups. Binary logistic regression analyses with a forward stepwise method were performed to explore the risk factors for renal dysfunction in hospitalized patients with normoalbuminuric T2DM.Results: Among the 1620 patients evaluated, 500 (30.9%) had DKD, of which 9% had NADKD. The prevalence of stroke, cardiovascular events, carotid plaque, and peripheral arterial disease in NADKD was significantly higher than in a non-DKD control group (normoalbuminuric T2DM patients with eGFR of ≥60 ml/min/1.73 m2). Regression analyses revealed that three significant independent factors were associated with NADKD: age (OR = 1.089, confidence interval [CI] 95% [1.055−1.123], p < 0.001), previous use of renin−angiotensin system inhibitors (RASIs; OR = 2.330, CI 95% [1.212−4.481], p = 0.011), and glycated hemoglobin (HbA1c; OR = 0.839, CI 95% [0.716−0.983], p = 0.03). Conclusions: NADKD is mainly associated with macrovascular rather than microvascular complications. NADKD is more common in patients with normoalbuminuric T2DM with older age, previous use of RASIs, and good glycemic control.

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How does CKD affect HbA1c?

Abstract: A number of factors determine HbA1c other than the level of glucose exposure alone. 1 In an subset analysis of

Cited by 25 publications

References 5 publications

Influence of serum albumin on HbA1c and HbA1c-defined glycemic status: a retrospective study

Influence of serum albumin on HbA1c and HbA1c-defined glycemic status: a retrospective study

Predictors of treatment failure during the first year in newly diagnosed type 2 diabetes patients: a retrospective, observational study

Clinical Features of And Risk Factors for Normoalbuminuric Diabetic Kidney Disease In Hospitalized Patients With Type 2 Diabetes Mellitus: A Retrospective Cross-Sectional Study

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