Can Glycohemoglobin Be Used to Assess Glycemic Control in Patients with Chronic Renal Failure

Many factors can affect interpretation of glycohemoglobin (GHB/HbA1c) measurements in patients with chronic renal failure (CRF). Several reports have suggested that erythrocyte survival is substantially lowered in most patients with CRF; this would be expected to lower GHB results (1)(2)(3)(4)(5)(6). Several reports have also suggested that GHB methods, especially those based on charge separation (e.g., ion-exchange HPLC), may have interference by carbamylated hemoglobin that would be expected to falsely increase GHB results (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Many of these reports evaluated older assay methods; newer ion-exchange methods may show improved separation of the HbA1c fraction from other hemoglobin adducts (15)(17). Because renal failure is common in patients with diabetes and GHB is widely used as an index of mean blood glucose in these patients, we examined GHB results in patients with CRF by several different GHB assay methods. We also investigated the impact of shortened erythrocyte lifespan by comparing the GHB results obtained for nondiabetic patients with and without CRF. Fifty-five patients with CRF (blood urea nitrogen >400 mg/L) were recruited for this study. Twenty-nine were not receiving dialysis and …