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Titolo Using Hemoglobin A1c to Derive Mean Blood Glucose in Peritoneal Dialysis Patients
Autore Junichi Hoshino a, b, h Rajnish Mehrotra c Connie M. Rhee a, d Kunihiro Yamagata I Yoshifumi Ubara h Kenmei Takaichi h Csaba P. Kovesdy e, f Miklos Z. Molnar a, j, k Kamyar Kalantar-Zadeh a, g a Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, Calif. , b Department of Epidemiology, UCLA School of Public Health, Los Angeles, Calif. , c Division of Nephrology, Harborview Medical Center, University of Washington, Seattle, Wash. , d Division of Nephrology, Brigham and Women’s Hospital, Boston, Mass. , e Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis Tenn. , f University of Tennessee Health Science Center, Memphis, Tenn. , and g Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, Calif. , USA; h Nephrology Center, Toranomon Hospital, Tokyo , and i Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba , Japan; j Institute of Pathophysiology, Semmelweis University, Budapest , Hungary; k Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ont. , Canada
Referenza Am J Nephrol 2013; 37:413–420
Contenuto

Background: Although hemoglobin A1c (HbA1c) has been widely used as a clinical assessment tool for outcome
analyses related to glycemic control, the relationship between HbA1c and average blood glucose (BG) specific to peritoneal dialysis (PD) patients with diabetes has not been characterized. We sought to develop HbA1c-BG equation
models for PD patients.

Methods: We examined associations between HbA1c and random serum BG values over time in a contemporary 5-year (2001–2006) cohort of DaVita PD patients with diabetes. We identified 850 patients (mean age: 58 ± 13 years, 56% male) with 4,566 paired measurements of HbA1c and BG. The bootstrapping method was used to estimate average BG and corresponding HbA1c.

Results: Linear regression analyses yielded the following HbA1c-BG equations: (1) BG (mg/dl) = 24.1 + 8.6 × HbA1c – 12.2 × albumin [adjusted R 2 (R 2 adj = 0.454)], (2) BG = 55.3 + 28.8 × HbA1c – 10.2 × Albumin – 3.3 × Hb (R 2 adj = 0.457), and (3) BG = 69.5 + 28.7 × HbA1c – 10.1 × albumin – 3.7 × Hb – 0.1 × age + race/ethnicity (–10.1 African Americans, –5.4 other race/ethnicities; R 2 adj = 0.457). All models showed greater explanatory power of BG variation than previously established HbA1c-BG equation models defined within non-PD cohorts [R 2 adj = 0.446 for both the Diabetes Control and Complications Trial (DCCT) and the A1c-Derived Average Glucose (ADAG) equations].

Conclusions: The association between HbA1c and BG in PD patients is different than that of patients with normal kidney function. Our analysis suggests that equations incorporating serum albumin and/or Hb values better estimate the HbA1c-BG relationship in PD patients compared to equations using HbA1c alone.

 

 

 

 

Data 06.11.2013
 
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