Is the testing of glycated hemoglobin (hba1c) significant in chroniodialysis patients?

Medical Review (Med. pregled), 2024, 60(2), 65-69.

Al. Osichenko

Clinic of Hemodialysis, Acidadem City Clinic Tokuda Hospital Sofia

Abstract. Blood sugar control is vitally important to the proper treatment of the patients with diabetes mellitus. The assessment of glycated hemoglobin (HbA1c) is the gold standard for long-term glycemic monitoring. In 2022, KDIGO published Clinical Practice Guidelines for the Control of Diabetes Mellitus in Patients with Chronic Kidney Disease (CKD). The Expert Working Group specifically states that the significance of HbA1c measurement decreases in advanced CKD (G4–G5), especially among the dialysis patients. HbA1c values are affected by: 1) the blood sugar variations over the past 8-12 weeks; 2) the factors influencing the glycation process; 3) the number and quality of the red blood cells. The correlation between glycemia, hemoglobin glycation susceptibility and erythrocyte quality and quantity differ between these patients and the general population, leading to an imbalance in the relationship between HbA1c and mean blood glucose. For this reason, KDIGO accepts that HbA1c does not reflect the glycemic control in the dialysis patients and glycated hemoglobin values should be interpreted with caution. Since it is not affected by CKD in these patients, daily self-monitoring of blood glucose levels is considered to be more reliable.

Key words: hemodialysis, diabetes mellitus, blood sugar, glycated hemoglobin

Address for correspondence: Assoc. Prof. Dr Aleksandar Osichenko, Clinic of Hemodialysis, Acibadem City Clinic Tokuda Hospital, 51B Nikola Vaptsarov Blvd., Bg – 1407 Sofia, e-mail: alosichenko@abv.bg