Abstract: SA-PO970

HbA1c Underestimated Glucose Level in Diabetic PD Patients Compared to Normal Kidney Function Diabetic Patients

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Zheng, Hua, Peking Union Medical College , Beijing, China
  • Chen, Limeng, Peking Union Medical College Hospital, Beijing, China
Background

HbA1C is widely used as glycemic marker for general DM patients. However, its accuracy has been questioned in ESRD patients for potential effect of renal anemia, EPO usage and uremia on glycation physiology. Most research relevant to the topic was done in hemodialysis. Yet, reports on whether HbA1C underestimated glucose level in PD patients were contradictory. This research aimed to compare HbA1C value adjusted with mean glucose in PD DM and DM patients with normal kidney function (NKF) and the potential cause of the difference.

Methods

Twenty DM PD patients were enrolled in this single-centered prospective research for 72-hour Continuous Glucose Monitoring (CGM). PD patients were matched with twenty DM NKF patients based on 72-hour mean glucose (MG), age and gender who underwent CGM during the same period.

Results

One PD patient was discarded for incomplete data. No significant gender and age difference was detected between PD and NKF patients. For PD patients, mean EPO dose for previous three months was 8002 IU per week. Mean Hgb was 106.8g/L.
PD and NKF patients had negligible MG (8.8±1.9 vs 8.7±1.7 mmol/L, p=0.868) with significantly different HbA1C value (6.17%±0.87% vs 6.93%±1.02%, p=0.043). PD patients also had worse linear correlation than NKF patients. Significant different regression formula was found between PD and NKF patients (p for intercept=0.02). PD patients had 0.79% lowered absolute value than NKF patients for HbA1C (6.15% vs 6.94%, p < 0.001) at pooled mean MG (8.74mmol/L). Further analysis on regression residuals or residuals over estimated HbA1C found that this difference could not be explained by EPO dose (p=0.733), hemoglobin (p=0.727), urea (p=0.934), creatinine (p=0.648), albumin (p=0.582), residual GFR (p=0.767) or nPCR (p=0.408).

Conclusion

HbA1C significantly underestimated glucose level in diabetic PD patients compared to normal kidney function diabetic patients. The difference might not be simply explained by hemoglobin, EPO injection dose, uremia, residual GFR, albumin, or nPCR.