Influence of albumin leakage on glycated albumin in patients with type 2 diabetes undergoing hemodialysis

Glycated albumin (GA) is recommended as a better glycemic indicator than HbA1c in patients undergoing hemodialysis, because red blood cell lifespan is generally faster than that in normal subjects and easily altered by blood loss and erythropoiesis-stimulating agent administration. However, GA can be also affected by protein loss in urine and hemodialysis fluid. Therefore, in this study, we investigated the effect of albumin leakage induced by hemodialysis on GA in a crossover manner. Nine patients undergoing hemodialysis with large or small amounts of albumin leakage were observed for nine months. Valuables indicating glycemic control, albumin and hemoglobin metabolism and nutritional status were evaluated. As a result, it was shown that albumin leakage could affect GA, but the effect was practically small considering the prescription of diabetic drugs. The correlation between HbA1c and blood glucose levels was similar with that between GA and blood glucose levels in our study. In conclusion, GA was a reliable indicator, even with the change of hemodialysis modality. The influence of clinically acceptable albumin leakage induced by hemodialysis on GA was negligible practically. We should recognize that the preferable glycemic indicator in patients undergoing hemodialysis depends on the hemoglobin and albumin metabolism of each patient.

内容要旨・審査要旨・論文本文の公開
本論文は，著者Sayo Uedaの学位論文として提出され，学位審査・授与の対象となっている。
This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use (https://www.springernature.com/gp/open-research/policies/accepted-manuscript-terms), but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1007/s10047-019-01097-4