Abstract MP016: Glycated Albumin and Fructosamine May Not Overcome Limitations of HbA1c in the Setting of Chronic Kidney Disease
Introduction: Alterations in red blood cell turnover in the setting of chronic kidney disease (CKD) may limit the interpretability of hemoglobin A1c (HbA1c) as a measure of diabetic glucose control. Where HbA1c is problematic, glycated albumin and fructosamine have been proposed as better markers of hyperglycemia. We investigated whether the associations of HbA1c, glycated albumin, and fructosamine with fasting glucose and HbA1c varied by CKD stage.
Methods: We performed a cross-sectional analysis of 1,678 persons with diagnosed diabetes aged 65 years or older from the Atherosclerosis Risk in Communities Studies (list 5, 2011-2013). We compared Spearman’s rank correlation coefficients and root mean square error (RMSEs) for HbA1c, glycated albumin, and fructosamine with fasting glucose and HbA1c across CKD stages. CKD stages were defined using estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR).
Results: Mean age was 76 years, 54% (910 of 1,678) were female, and 29% (479 of 1,678) were black. The associations of HbA1c, glycated albumin, and fructosamine with fasting glucose were weaker (lower correlations and higher RMSEs) in persons with worse kidney function compared to those with preserved kidney function (Table). Both glycated albumin and fructosamine had stronger associations with HbA1c compared to fasting glucose and their associations with HbA1c were relatively similar across CKD stages.
Conclusions: In persons with worse kidney function, HbA1c, glycated albumin, and fructosamine were all poorly correlated with fasting glucose. Yet the associations between glycated albumin and fructosamine with HbA1c were similar across CKD stages. Our data suggest that glycated albumin and fructosamine might not overcome limitations of HbA1c as a marker of hyperglycemia in older adults with CKD.
Author Disclosures: M. Jung: None. B. Warren: None. M. Grams: None. D. Kwong: None. T. Shafi: None. J. Coresh: None. C. Rebholz: None. E. Selvin: None.
- © 2017 by American Heart Association, Inc.