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.