Target for Glycemic Control in Type 2 Diabetic Patients on Hemodialysis: Effects of Anemia and Erythropoietin Injection on Hemoglobin A1c

In hemodialysis (HD) patients the glycated hemoglobin (HbA1c) level may underestimate glycemic control. The aim of this study is to estimate accurate glycemic control in type 2 diabetic patients on HD. Type 2 diabetes patients (N = 87) who had been receiving maintenance HD for at least one year were enrolled. HbA1c and the percentage of glycated albumin relative to total the serum albumin (%GA) were measured in blood samples and the factors that affected the %GA/HbA1c ratio were examined. There were significant and positive correlations between the plasma glucose and either the HbA1c levels (r = 0.539, P < 0.01) or the %GA level (r = 0.520, P < 0.01). No relationship between the serum albumin levels and %GA levels was observed. A weekly dose of erythropoietin (EPO) was positively correlated with the ratio of %GA/HbA1c and hematocrit (Ht) correlated negatively. There was no significant correlation between the %GA/HbA1c level and the EPO dose in patients with Ht ≥ 30%, although a significant correlation was found between those parameters in the Ht < 30% group. The mean of the %GA/HbA1c ratios in patients with Ht ≥ 30%, with Ht < 30% and treated with EPO < 100 IU/kg/week, and with Ht < 30% and treated with EPO ≥ 100 IU/kg/week were 3.41, 3.56 and 4.13, respectively. In HD patients, accurate glycemic control may be estimated as: HbA1c × 1.14 if Ht ≥ 30%; HbA1c × 1.19 if Ht < 30% and treated with low dosages of EPO; and HbA1c × 1.38 if Ht < 30% and treated with high dosages of EPO.