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Abstract: SA-PO399

Glycated Albumin to Glycated Hemoglobin Ratio and Mortality in Diabetic Patients on Dialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Hoshino, Junichi, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Japan
  • Abe, Masanori, Nihon Daigaku Igakubu Daigakuin Igaku Kenkyuka, Itabashi-ku, Japan
  • Hamano, Takayuki, Nagoya Shiritsu Daigaku Daigakuin Igaku Kenkyuka Igakubu, Nagoya, Japan
  • Hasegawa, Takeshi, Showa Daigaku, Shinagawa-ku, Japan
  • Wada, Atsushi, Kitasaito Byoin, Asahikawa, Japan
  • Nakai, Shigeru, Fujita Ika Daigaku, Toyoake, Japan
  • Hanafusa, Norio, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Japan
  • Masakane, Ikuto, Yabuki Hospital, Yamagata, Japan
  • Nitta, Kosaku, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Japan

Hemoglobin A1c (A1c) and glycated albumin (GA) are two blood glycated proteins commonly used to monitor glycemic control in dialysis patients with diabetes. However, little is known about the association between the GA/A1c ratio and mortality in these populations. Here, we examine these associations using a nationwide cohort.


We enrolled 28,994 dialysis patients with diabetes who met our inclusion criteria (female, 32.9%; mean age, 67.4±11.6 years; mean dialysis duration, 6.3±5.8 years). After dividing the patients into groups based on GA/A1c quantiles and adjusting for 18 potential confounders, adjusted hazard ratios and 95% confidence limits were calculated for 3-year mortality and cause-specific mortalities. Additionally, propensity score matching analyses were used to compare mortalities between the low and high GA/A1c groups.


After adjusting for possible confounders, significantly worse mortality was found in patients with GA/A1c ratios of 3.6-4.0 (HR 1.21 (1.10-1.34)) or higher (HR 1.43 (1.30-1.58)) than in those with GA/A1c ratios of 3.0-3.3. The risks of infectious and cardiovascular death were higher in these patients regardless of their nutritional status. In the propensity score matching analyses, significantly worse mortality was consistently found in those with a higher ratio (≥3.3) (HR 1.23 (1.14-1.33)) than in those with a lower ratio.


The GA/A1c ratio was significantly associated with 3-year mortality, especially infectious and cardiovascular mortality, in dialysis patients with diabetes. It is a promising new clinical indicator of survival in these patients, independent of their current glycemic control and nutritional markers.