Measurement of Hba(1C) in patients with chronic renal failure.
Measurement of Hba(1C) in patients with chronic renal failure.
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DOI：
10.1016/j.cca.2012.12.022
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发表时间：
2013-03-15
期刊：
影响因子：
--
通讯作者：
Roberts W
中科院分区：
文献类型：
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作者：
Little RR;Rohlfing CL;Tennill AL;Hanson SE;Connolly S;Higgins T;Wiedmeyer CE;Weykamp CW;Krause R;Roberts W
据报道，氨甲酰血红蛋白（carbHb）会干扰糖尿病慢性肾功能衰竭（CRF）患者HbA 1c的测量和解读。还有人担心，由于红细胞存活期缩短，这些患者的HbA 1c结果可能较低。我们评估了carbHb对HbA 1c测量的影响，并在有和无肾脏疾病的患者中比较了HbA 1c与糖化白蛋白（GA），以测试CRF是否会导致使用11种测定方法的HbA 1c结果的临床显著偏倚。受试者包括患有和不患有肾衰竭和糖尿病的受试者。每例受试者的估计肾小球滤过率（eGFR）用于确定肾脏疾病的存在和程度。使用多元回归模型确定从每种测试方法和比较方法获得的HbA 1c结果之间的关系是否受到eGFR的显著影响（p<0.05）。使用在6或9%HbA1c时eGRF四分位数>7%之间的差异进一步评价这些方法的临床意义。比较有无肾功能衰竭患者糖化血红蛋白（HbA 1c）与糖化白蛋白（GA）的关系。一些方法显示eGFR的影响较小但具有统计学显著性;这些差异均无临床显著性。如果假设GA能更好地反映血糖控制，则肾衰竭患者的HbA 1c约低1.5%。虽然大多数方法可以准确地测量肾衰竭患者的HbA 1c，但由于肾衰竭患者红细胞存活期缩短的倾向，医疗保健提供者必须谨慎地解释这些患者的检测结果。
Carbamylated hemoglobin (carbHb) is reported to interfere with measurement and interpretation of HbA1c in diabetic patients with chronic renal failure (CRF). There is also concern that HbA1c may give low results in these patients due to shortened erythrocyte survival. We evaluated the effect of carbHb on HbA1c measurements and compared HbA1c with glycated albumin (GA) in patients with and without renal disease to test if CRF causes clinically significant bias in HbA1c results using 11 assay methods. Subjects included those with and without renal failure and diabetes. Each subject’s estimated glomerular filtration rate (eGFR) was used to determine the presence and degree of renal disease. A multiple regression model was used to determine if the relationship between HbA1c results obtained from each test method and the comparative method were significantly (p<0.05) affected by eGFR. These methods were further evaluated for clinical significance using difference between the eGRF quartiles of >7% at 6 or 9% HbA1c. The relationship between HbA1c and glycated albumin (GA) in patients with and without renal failure was also compared. Some methods showed small but statistically significant effects of eGFR; none of these differences were clinically significant. If GA is assumed to better reflect glycemic control, then HbA1c was approximately 1.5% HbA1c lower in patients with renal failure. Although most methods can measure HbA1c accurately in patients with renal failure, healthcare providers must interpret these test results cautiously in these patients due the propensity for shortened erythrocyte survival in renal failure.