A critical evaluation of glycated protein parameters in advanced nephropathy: a matter of life or death: A1C remains the gold standard outcome predictor in diabetic dialysis patients. Counterpoint.
A critical evaluation of glycated protein parameters in advanced nephropathy: a matter of life or death: A1C remains the gold standard outcome predictor in diabetic dialysis patients. Counterpoint.
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DOI：
10.2337/dc12-0483
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发表时间：
2012-07
期刊：
影响因子：
16.2
通讯作者：
Kalantar-Zadeh K
中科院分区：
文献类型：
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作者：
Kalantar-Zadeh K
慢性肾脏疾病仍然是糖尿病患者的主要并发症之一，并导致相当大的发病率。接受透析治疗的个体，其中一半是糖尿病患者，每年的死亡率为20%。了解与死亡率有关的因素仍然是一个优先事项。在透析单位之外，糖化血红蛋白毫无疑问是血糖控制的“黄金标准”。然而，最近在大量糖尿病透析患者中有证据表明，较高和较低水平的A1C与死亡率相关。鉴于透析患者代谢失调的独特情况，迫切需要确定准确的检测方法来监测与心血管终点相关的血糖控制。在这个分两部分的对位叙述中，dr。Freedman和Kalantar-Zadeh对糖化血红蛋白在心血管疾病和生存中的作用以及考虑使用其他短期血糖指标持反对意见。在这一对比之前的叙述中，Freedman博士建议糖化白蛋白可能是透析患者首选的血糖指标。在下面的对照叙述中，Kalantar-Zadeh博士为使用A1C作为透析患者血糖管理的毋庸置疑的黄金标准进行了辩护。——william T. Cefalu，医学博士，《糖尿病护理》杂志主编
Chronic kidney disease remains as one of the major complications for individuals with diabetes and contributes to considerable morbidity. Individuals subjected to dialysis therapy, half of whom are diabetic, experience a mortality of ∼20% per year. Understanding factors related to mortality remains a priority. Outside of dialysis units, A1C is unquestioned as the “gold standard” for glycemic control. In the recent past, however, there is evidence in large cohorts of diabetic dialysis patients that A1C at both the higher and lower levels was associated with mortality. Given the unique conditions associated with the metabolic dysregulation in dialysis patients, there is a critical need to identify accurate assays to monitor glycemic control to relate to cardiovascular endpoints. In this two-part point-counterpoint narrative, Drs. Freedman and Kalantar-Zadeh take opposing views on the utility of A1C in relation to cardiovascular disease and survival and as to consideration of use of other short-term markers in glycemia. In the narrative preceeding this counterpoint, Dr. Freedman suggests that glycated albumin may be the preferred glycemic marker in dialysis subjects. In the counterpoint narrative below, Dr. Kalantar-Zadeh defends the use of A1C as the unquestioned gold standard for glycemic management in dialysis subjects. —William T. Cefalu, MD Editor in Chief, Diabetes Care