Serum fructosamine versus glycosylated hemoglobin as an index of glycemic control, hospitalization, and infection in diabetic hemodialysis patients

Abstract

Diabetes is the most common cause of end-stage renal disease and an important risk factor for morbidity and mortality in dialysis patients. Glycemic control, utilizing serial measurement of glycosylated hemoglobin (HbA1c), is generally recommended to limit end-organ damage, including cardiovascular morbidity and mortality. We, along with others, have previously suggested that HbA1c may not be a reliable measure of glycemic control in dialysis patients, and have therefore explored the use of serum fructosamine (SF) as an alternative marker. The objective of this study was to compare HbA1c levels with SF in monitoring glycemic control and associated morbidity (infection and hospitalization) in diabetic patients in a large urban hemodialysis (HD) center. We enrolled 100 diabetic HD patients and followed them up prospectively for 3 years. Data on demographics, as well as biochemical and clinical data, including hospitalizations and infections, were recorded. The mean age was 63 years. In all 54% were women and the majority were African Americans (72%). As expected, HbA1c and albumin-corrected fructosamine (AlbF) levels were highly correlated and both were significantly associated with serum glucose. AlbF, however, was more highly correlated with mean glucose values when less than 150 mg/dl and was a more useful predictor of morbidity. By univariate logistic regression and by Poisson regression analysis, AlbF, but not HbA1c, was a significant predictor of hospitalization. Additionally, in patients dialyzed by arteriovenous (AV) access (that is, excluding those dialyzed via vascular catheters), AlbF, but not HbA1c, was a significant predictor of infection. In conclusion, AlbF is as reliable a marker as HbA1c for glycemic control in diabetic patients on HD, and may be advantageous for patients with serum glucose in a desirable therapeutic range (<150 mg/dl). In addition, AlbF, but not HbA1c, is associated with morbidity (hospitalizations and infections) in diabetic patients on HD.

Evaluation of Glycemic Variability in Well-Controlled Type 2 Diabetes Mellitus

“…37 Some studies have reviewed the usefulness of FA. [37][38][39] It has been suggested that FA testing should be performed as a routine check in diabetes patients with normal HbA1c concentrations to confirm that their glucose is under control. 37 This study measured MAGE c and MAGE gos with CGMS data as markers for glucose variability.…”

Is HbA1c the only choice? Alternative biomarkers for glycaemic control assessment

“…Research in patients with chronic kidney diseasestage 3 and 4 -has shown a correlation between frutosamine levels and good glycaemia control in diabetic patients; however the estimated mean glucose level based on fructosamine was significantly undervalued [27]. Different research has shown a correlation -in hemodialysis patients -between fructosamine levels adjusted to actual albumin concentrations and glycaemia control similar to this of HbA 1c [28].…”

Frutosamina como principal parâmetro glicêmico do paciente diabético em hemodiálise

“…Com a crescente diminuição da função renal há o desenvolvimento da acidose sistêmica e isto contribui ao falso aumento dos valores da HbA1c 42 . Estudo realizado por Mittman et al 43 mostrou que a utilização da frutosamina refletiu melhor que a HbA1c nos níveis glicêmicos de pacientes diabéticos em tratamento por hemodiálise. É conveniente ressaltar que os autores indicam que a frutosamina deve ser corrigida de acordo com a concentração plasmática de albumina, pois este procedimento a torna mais fidedigna com o perfil de acompanhamento do paciente diabético.…”

“…Mittman et al 43 Serum fructosamine versus glycosylated hemoglobin as an index of glycemic control, hospitalization, and infection in diabetic hemodialysis patients (2010)…”