الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 32 |  |  |
| | | from | 32 | | |
Abstract
Strict glycemic control has beneficial effects on the prognosis of patients who have diabetes with chronic kidney disease and undergo regular hemodialysis.
Various parameters including fasting glucose level, postprandial glucose level, and glycated hemoglobin are used to great effect in determining the glycemic status of patients
However, some reports indicate that HbA1c might not provide a relevant assay for glycemic control in HD patients. This is attributed to the decrease in the life span of erythrocytes due to the uremic environment, blood loss during treatment, frequent blood sampling, RBCs transfusions and EPO treatment. Also HbA1c represents time-averaged PG level over 3-4 months. So that concerns exist regarding the use of this marker to guide glycaemic control along with the potential risk of exposing this population to an increased risk of hyperglycaemic-related complications.
Serum glycated albumin was hypothesized to be alternative marker for glycemic control in patients with diabetes as it is not affected by the changes in the survival time of erythrocytes in the case of type 2 diabetes with hemoglobinopathy.
The aim of this study was to assess the utility of glycated albumin as a substitute to HbA1c quantification for the accurate assessment of glycemic control in patients with end stage renal disease. In addition, to attempt to develop an estimating equation for investigating the relationship between glycated albumin and average glucose levels.
Therefore we conducted this study at the hemodialysis centre of Ain Shams University Hospital. A total of 74 subjects were included in the study. They were divided into 3 subgroups: subgroup Ia; diabetics with normal renal function (n=18), subgroup Ib; diabetics with chronic kidney disease (n=23) and subgroup Ic; diabetic patients on hemodialysis (n=33) and group II: control group (n=15) with matching age and sex.
Our results revealed that there were highly significant differences among the different groups of the study as regard to the mean values ± SD of DM ttt regimen, serum urea, serum creatinine, blood haemoglobin, Alb/Creat ratio, eGFR, HbA1c and SMBG. Also it showed no significant differences among the different groups of the study as regard to the mean values ± SD of serum albumin and GA%.
There were significant positive correlations of HbA1c with GA%, SMBG with HbA1c and SMBG with GA% in all subgroups.
Also we evaluated how to calculate estimated average glucose level (eAG) from GA% and developed an estimating equation with a regression line of:
eAG = -11.862 + (8.479 × GA%)
Multiple linear regression analysis showed that eGFR, HbA1c and GA% are independent predictors for SMBG in all diabetic patients using the equation:
eAG= -29.724 + (eGFR × -0.287) + (HbA1c × 24.953) + (GA% × 2.691)
ROC curve analysis showed that HbA1c and GA have the same diagnostic performance as markers of uncontrolled hyperglycemia (SMBG > 180mg/dl) in diabetic patients with normal renal function and diabetic patients with chronic kidney disease. It also showed that the diagnostic performance of GA as marker of uncontrolled hyperglycemia (SMBG > 180mg/dl) was better than that of HbA1c in diabetic patients on hemodialysis; having higher AUC.