U.S. Department of Health and Human Services

Test Predicts Outcomes in Dialysis Patients with Diabetes

​In dialysis patients with diabetes, measuring another set of modiied blood proteins may better predict the risk of death and cardiovascular disease (CVD) than the current standard test to assess blood glucose control used in the general diabetes population.

Diabetes is the leading cause of kidney failure, also termed end-stage renal disease (ESRD). Patients with ESRD have extremely poor survival rates, with fewer than 50 percent surviving three years after initiating dialysis. The leading cause of death in these individuals is CVD. The standard test used to determine blood glucose levels over the previous three months—hemoglobin A1c (HbA1c)—detects the fraction of circulating hemoglobin that has a glucose molecule attached to it. However, in people receiving hemodialysis—a process in which the blood is removed from the body, iltered, and returned—red blood cells, which contain hemoglobin, survive much less than three months. Thus, HbA1c can be misleading as a measure of long-term blood glucose control in these people. Alternatives to the HbA1c test exist, but they have not been evaluated with respect to long-term outcomes in dialysis patients.

To test other approaches to measuring blood sugar levels, and to evaluate their association with outcomes in dialysis patients, scientists examined blood samples from over 500 participants in a clinical trial; samples were taken at the time that the participants initiated dialysis and again at an average of ive months later. The researchers measured total glycated proteins, which represent all blood proteins that have a glucose molecule attached to them, and glycated albumin, which detects the fraction of the relatively common blood protein albumin that has undergone the same modiication. They asked whether there was a correlation between elevated levels of these two values and increased risk of cardiovascular events, hospitalization due to sepsis (a serious bacterial infection), or death over an average follow-up period of three and a half years.

The analysis of the blood samples showed that elevated levels of overall glycated protein and the fraction of glycated albumin were associated with an increased risk of death from any cause, death from CVD, or time to irst CVD event (for example, a non-fatal heart attack or stroke). In participants on dialysis, measurement of these markers may provide a more accurate representation of a given participant’s blood glucose control, provide important information about risk of death and CVD, and could be useful for the management of diabetes in people who are on dialysis.

Shai T, Sozio SM, Plantinga LC, et al. Serum fructosamine
and glycated albumin and risk of mortality and clinical
outcomes in hemodialysis patients. Diabetes Care
36: 1522-1533, 2013.