HbA1C Test Poorly Predictive in Dialysis Patients

Posted on June 12, 2011

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Conventional glucose control monitoring methods may not be as meaningful in diabetes patients with end-stage renal disease, researchers found. Patients on dialysis will normally show a lower A1c than they actually have, giving patients and physicians a false sense of security.

While the American Diabetes Association has deemed the HbA1c test an effective tool for diagnosing diabetes, kidney doctors recently determined that the HbA1c is not as useful for managing patients with diabetes and advanced kidney failure. Another test, the glycated albumin or GA assay, appears to be far more effective in this setting.

Barry I. Freedman, M.D., John H. Felts III Professor and lead investigator explained that, “Many organs don’t function properly in severe kidney failure.” “For example, most dialysis patients have anemia with fewer red blood cells than they should, which has a dramatic impact on the accuracy of the HbA1c reading.”

“This is the first study showing that a blood sugar test predicts risk of death in diabetic dialysis patients, as well as risk of hospitalization,” Freedman said. “This test provides the missing link that will allow dialysis patients and physicians to accurately gauge risk. The association is clear: high GA readings predict higher risk.”

Freedman suggests physicians not rely on the HbA1c in dialysis patients, instead suggesting that blood glucose levels be directly monitored with multiple daily readings until the GA test is available in the states.

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