Glycated hemoglobin or glycated albumin for assessment of glycemic control in hemodialysis patients with diabetes?

This commentary discusses the findings of a study by Peacock et al., who measured levels of glycated hemoglobin (HbA(1c)) and glycated albumin in patients with diabetes who either were or were not on hemodialysis in an effort to determine which marker is the better indicator of glycemic control. They found that HbA(1c) and glycated albumin levels are both independently associated with serum glucose level. However, HbA(1c) level--unlike glycated albumin level--was also influenced by hemodialysis, hemoglobin level, and erythropoietin dose. Although we agree that glycated albumin level could be a better indicator of glycemic control than HbA(1c) level in patients on hemodialysis who have diabetes and anuria, this conclusion might not be applicable to patients with massive proteinuria or to those on peritoneal dialysis. Further studies are required to confirm the target glycated albumin level that is necessary to ensure a good prognosis for patients with diabetes who are on hemodialysis because no clear consensus has yet been reached. In addition, more data are needed to determine at which stage of kidney disease measurement of glycated albumin levels becomes preferable to assessment of HbA(1c) level.