Influence of Erythropoiesis-Stimulating Agents on HbA1c and Fructosamine in Patients with Haemodialysis

Rasche, Franz Maximilian; Ebert, Thomas; Beckmann, Julia; Busch, Volker; Barinka, Filip; Rasche, Wilma Gertrud; Lindner, Tom H.; Schneider, Jochen G.; Schiekofer, Stephan

doi:10.1055/s-0042-124577

Cited by 14 publications

(10 citation statements)

References 42 publications

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“…Glycated albumin is the percentage of serum albumin to which a glucose molecule has been nonenzymatically attached, while fructosamine refers to all ketoamine linkages resulting from serum protein glycation (11). In particular, these biomarkers are not based on hemoglobin and hence, do not depend on RBC turnover (6,12). In addition, with a shorter half-life than hemoglobin, glycated proteins reflect average glycemic burden of the previous 2-3 weeks and so may be better suited than HbA 1c to monitor shorter-term changes in glycemia (2,11).…”

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confidence: 99%

Continuous Glucose Monitoring and Use of Alternative Markers To Assess Glycemia in Chronic Kidney Disease

et al. 2020

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In chronic kidney disease, glycated albumin and fructosamine have been postulated to be better biomarkers of glycemic control than HbA 1c . We evaluated the accuracy, variability, and covariate bias of three biomarkers (HbA 1c , glycated albumin, and fructosamine) compared with continuous glucose monitoring (CGM)-derived measurement of glycemia across estimated glomerular filtration rate (eGFR) in type 2 diabetes. RESEARCH DESIGN AND METHODSA prospective cohort study was conducted of 104 participants with type 2 diabetes, 80 with eGFR <60 mL/min/1.73 m 2 (not treated with dialysis) and 24 frequency-matched control subjects with eGFR ‡60 mL/min/1.73 m 2 . Participants wore a blinded CGM for two 6-day periods separated by 2 weeks, with blood and urine collected at the end of each CGM period. HbA 1c , glycated albumin, and fructosamine were measured by high-performance liquid chromatographic, enzymatic, and colorimetric nitroblue tetrazolium methods, respectively. RESULTSWithin-person biomarker values were strongly correlated between the two CGM periods (r 5 0.92-0.95), although no marker fully captured the within-person variability of mean CGM glucose. All markers were similarly correlated with mean CGM glucose (r 5 0.71-77). Compared with mean CGM glucose, glycated albumin and fructosamine were significantly biased by age, BMI, serum iron concentration, transferrin saturation, and albuminuria; HbA 1c was underestimated in those with albuminuria. CONCLUSIONSGlycated albumin and fructosamine were not less variable than HbA 1c at a given mean CGM glucose level, with several additional sources of bias. These results support measuring HbA 1c to monitor trends in glycemia among patients with eGFR <60 mL/min/1.73 m 2 . Direct measurements of glucose are necessary to capture short-term variability.Glycated hemoglobin (HbA 1c ) is commonly used in people with diabetes to monitor long-term (;3 months) glycemic control. However, HbA 1c may not appropriately measure glycemic burden in those who also have chronic kidney disease (CKD), with both bias (defined as a difference in mean values) and more variability around the

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confidence: 99%

Continuous Glucose Monitoring and Use of Alternative Markers To Assess Glycemia in Chronic Kidney Disease

et al. 2020

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“…In addition to HbA1c, other markers of glycemia have been studied in recent years. Glycated serum proteins, such as glycated albumin and fructosamine, which are not based on hemoglobin and hence do not depend on RBC turnover [18, 19], are considered alternative biomarkers of glycemic control. Previous studies have suggested that glycated albumin and fructosamine may be comparable or superior to HbA1c in dialysis patient [20, 21].…”

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confidence: 99%

Effects of Hemodialysis and Peritoneal Dialysis on Glycometabolism in Patients with End-Stage Diabetic Nephropathy

Chen¹,

Duan²,

Zhou³

2020

Blood Purif

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Objective: The objective is to study the fluctuation pattern of blood glucose spectrum in patients with end-stage diabetic nephropathy (ESDN) receiving hemodialysis (HD) and peritoneal dialysis (PD), respectively, and to compare the influences of these 2 dialysis methods on glycometabolism. Methods: Sixty-four dialysis patients with ESDN were recruited, including 35 HD patients and 29 PD patients. The 24-h blood glucose on dialysis days of the 2 groups was monitored by the continuous glucose monitoring system, and the relevant glycometabolism indexes were recorded and compared. Results: The control of blood glucose in both groups was not satisfactory. At the same blood glucose level, the dosage of exogenous insulin needed by patients in the PD group was larger than that in the HD group (p < 0.05). However, the fluctuation of blood glucose and consequently the incidence of hyperglycemia and hypoglycemia in HD group were greater than that in PD group (p < 0.05). The patients’ blood glucose levels decreased progressively during the course of HD. The mean blood glucose (MBG) values estimated by glycosylated hemoglobin (HbA1c) in both groups were lower than the actual measured blood glucose values (p < 0.05). Preliminary correlation analysis showed that the deviation of the MBG values estimated by HbA1c was positively correlated with the degree of anemia. Conclusion: HD patients have larger glycemic variability as compared with PD patients, while PD patients have overall increased blood glucose levels. Hypoglycemic programs should be made according to the corresponding changes in blood glucose. The HbA1c value of dialysis patients has a large deviation, so it is necessary to explore its influencing factors and develop more accurate blood glucose assessment indicators.

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“…Growing evidence suggests that the concentration of fructosamine also re ects the blood glucose level over the previous 2 to 3 weeks and may better monitor short-term changes in glycaemia [3,6,13,14]. In contrast to the HbA1c value in CKD patients, the fructosamine index does not depend on uraemia and anaemia [15]. However, fructosamine is generated from nonenzymatic glycation of serum protein, mainly albumin (~ 90%) [16].…”

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confidence: 99%

Evaluation of Fructosamine and Fructosamine-Albumin Ratio in Reflecting Fasting Glucose in Type 2 Diabetic Patients with Chronic Kidney Disease: A Case-Control Study

Dao

Nguyen

2022

Preprint

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Background Glycated haemoglobin (HbA1c) may not correctly reflect chronic glycaemic control in type 2 diabetes mellitus (T2DM) patients with chronic renal disease (CKD) due to anaemia. Growing evidence reports that fructosamine in reflecting glycaemic control is unaffected by anaemia in in these patients. However, the role of fructosamine remains unclear. Thus, this study aimed to evaluate the acceptance of HbA1c and determine whether fructosamine levels or fructosamine-albumin ratios might be promising biomarkers of glycaemic control in T2DM patients with or without CKD. Methods HbA1c and fructosamine levels were measured in 50 T2DM patients with CKD and 50 T2DM patients without CKD, together with 30 healthy subjects. The area under the curve and receiver operating characteristic curves were used to compare HbA1c, fructosamine levels, and fructosamine-albumin ratio in reflecting glycaemic control. Youden’s index was applied to identify the cut-off points for those parameters. The cut-off point for HbA1c was 6.0%, which was used as the standard method to determine the values of fructosamine and fructosamine-albumin ratio predictors for complications. Results HbA1c levels correlated strongly with fasting blood glucose in T2DM patients without CKD (r = 0.758, p < 0.01) and moderately (r = 0.575, p < 0.01) in those with CKD. However, fructosamine levels and the fructosamine-albumin ratios showed a moderate correlation with fasting blood glucose in those without CKD (r = 0.466, p < 0.01 and r = 0.436, p < 0.01, respectively). Estimated blood glucose levels calculated by HbA1c were similar to actual fasting blood glucose in T2DM patients with different levels of eGFR. However, for fructosamine levels and fructosamine-albumin ratios, the estimated blood glucose levels were similar to actual fasting blood glucose in groups of T2DM patients with eGFR levels lower than 45 and 30 mL/min/1.73 m2, respectively. The fructosamine-albumin ratio was a strong predictor of glycaemic control in T2DM patients with CKD (AUC = 0.923), comparable with HbA1c (AUC = 0.966). A fructosamine level of 270 µmol/L was identified as the optimal cut-off point for monitoring the response to T2DM treatment. Conclusion The fructosamine concentration or fructosamine-albumin ratio effectively reflected blood glucose levels in T2DM Vietnamese patients with CKD (eGFR levels lower than 45 and 30 mL/min/1.73 m2, respectively).

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Influence of Erythropoiesis-Stimulating Agents on HbA1c and Fructosamine in Patients with Haemodialysis

Cited by 14 publications

References 42 publications

Continuous Glucose Monitoring and Use of Alternative Markers To Assess Glycemia in Chronic Kidney Disease

Continuous Glucose Monitoring and Use of Alternative Markers To Assess Glycemia in Chronic Kidney Disease

Effects of Hemodialysis and Peritoneal Dialysis on Glycometabolism in Patients with End-Stage Diabetic Nephropathy

Evaluation of Fructosamine and Fructosamine-Albumin Ratio in Reflecting Fasting Glucose in Type 2 Diabetic Patients with Chronic Kidney Disease: A Case-Control Study

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