Relationship between glycosylated hemoglobin and blood glucose during progression of chronic kidney disease

Rajiv Agarwal, Robert P. Light

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Background: The value of measurement of glycosylated hemoglobin (HgbA 1C) in determining the degree of glycemic control in patients with chronic kidney disease (CKD) is unclear. Methods: A single-center, prospective cohort study was conducted in 128 veterans with diabetes mellitus and CKD. HgbA 1C was measured as clinically indicated and its relationship with random blood glucose (RBG) measurement evaluated prospectively over up to 10 years in three groups (end-stage renal disease (ESRD), CKD and controls who had diabetes but no CKD). Results: Between 1995 and 2011, in the control group, glycemic control as assessed by HgbA 1C was stable but improved when assessed by RBG. However, both the CKD and ESRD groups experienced declines in RBG and HgbA 1C. Declining HgbA 1C and RBG were noted prior to onset of dialysis. A fall in HgbA 1C remained after adjustment for RBG. A strong inverse relationship was seen between CKD stage and HgbA 1C even after adjusting for RBG such that the relationship between RBG levels and HgbA 1C was modified by CKD. Conclusions: In diabetic patients with late-stage CKD, glycemic control shows an improvement. However, HgbA 1C <7% may overestimate the degree of glycemic control. Therefore, reliance on HgbA 1C without home blood glucose monitoring may result in poor diabetes control.

Original languageEnglish (US)
Pages (from-to)32-41
Number of pages10
JournalAmerican journal of nephrology
Volume34
Issue number1
DOIs
StatePublished - Jul 1 2011

Keywords

  • Chronic kidney disease
  • Cohort studies
  • Diabetes mellitus
  • End-stage renal disease
  • Glycemic control

ASJC Scopus subject areas

  • Nephrology

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