A Critical Evaluation of Glycated Protein Parameters in Advanced Nephropathy: A Matter of Life or Death. A1C remains the gold standard outcome predictor in diabetic dialysis patients

摘要

Uremia may confound the association of A1C with time-averaged glucose concentration and the ability of A1C to predict clinical outcomes. These nondifferential alterations do not discredit A1C as a reliable long-term marker of glycemic control in dialysis patients as long as appropriate adjustments to interpret A1C values are made. Recent data from large cohorts of diabetic dialysis patients suggest a rather robust association between A1C and glucose concentration (r = 0.51-0.56) and U- or J-shaped AlC-mortality association with a shift to the right. Both very low (<6%) and high (>8%) A1C levels appear incrementally associated with higher all-cause and cardiovascular mortality in peritoneal and hemodialysis patients. These bimodal death risks are robust, especially when longitudinal A1C values are examined.