Monitoring Glycemic Control in End-Stage Renal Disease: What Should Be Measured?

[摘要] The study by Chen et al. (1) in this issue of Clinical Chemistry addresses an important and practical problem, namely how to monitor glycemia in patients with end-stage renal disease (ESRD).3 Recent estimates suggest that there are approximately 420 million people in the world with diabetes mellitus, a >2.5-fold increase since the turn of the 21st century. The dramatic rise in the prevalence of diabetes is mainly due to the global increase in the burden of overweight and obese individuals. The complications of diabetes have risen concomitantly with the increasing numbers of persons with the disease. Diabetes is the leading cause of chronic kidney disease (CKD), and is one of the most important risk factors for ESRD, cardiovascular disease, infection, and death in CKD patients (2). In the developed world, diabetes accounts for approximately 50% of ESRD cases, with the vast majority of these patients using dialysis as the primary mode of renal function.Several analytes, including glucose, hemoglobin A1c (Hb A1c), fructosamine, glycated albumin, and 1,5-anhydroglucitol, are used for the evaluation of glycemia (3). Although widely available, blood glucose is limited by lack of sample stability, concentrations are altered by numerous factors (including diet, stress, and illness), and it reflects glucose homeostasis at only a single point in time (4). Hb A1c is the analyte most widely measured to monitor long-term glycemic control. Glucose attaches to hemoglobin molecules over the lifetime of the erythrocyte, which is approximately 120 days. Therefore, Hb A1c reflects average glucose over the prior 8–12 weeks (5). The Hb A1c, which is used clinically to adjust therapy and as a marker of risk for the development of complications, is integral to the management of patients with diabetes and is also recommended for diagnosis. Nevertheless, Hb A1c is …

[学科分类] 过敏症与临床免疫学