Standard test for blood sugar control not accurate in diabetic dialysi...(nd GA levels despite paradoxically lower...),Health

Researchers believe the major reason for the discrepancy is that HbA1c depends on red blood cell survival and these cells dont live as long in hemodialysis patients. Most dialysis patients have anemia requiring treatment with medications that stimulate red blood cell production (erythropoietin).

The current study confirmed a report in Japanese patients and is the first to demonstrate the inaccuracy of the HbA1c in black and white dialysis patients. The Wake Forest researchers will soon determine whether these concerns also apply to patients on peritoneal dialysis and to people with kidney disease not yet on dialysis.

Controlling blood sugar is important because high levels are risk factors for developing hardening of the arteries (atherosclerosis) and lead to higher rates of kidney disease, heart attack, stroke, nerve damage and blindness. People with diabetes who undergo hemodialysis are at especially high risk. About one out of four diabetic dialysis patients (23 percent) in the U.S. will die from cardiovascular and infection complications during their first year on dialysis, and only 31 percent survive five years.

Control of blood sugar improves outcomes of diabetic patients, so accurate assessment is critical, said Freedman. This study supports the GA test as a more accurate measure of long-term blood sugar control among diabetic patients who are on hemodialysis.

The GA test is not currently available in the United States. Freedman said that until it is available, doctors and patients should be aware that the HbA1c underestimates glucose control and is affected by both erythropoietin administration and the hemoglobin concentration.

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