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Karger Publishers, American Journal of Nephrology, 1(33), p. 17-24, 2010

DOI: 10.1159/000322608

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Influence of Erythropoiesis-Stimulating Agents on Glycated Hemoglobin in Nondiabetic Kidney Diseases at the Start of Dialysis

This paper is available in a repository.
This paper is available in a repository.

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Abstract

<i>Background:</i> Although glycated hemoglobin (HbA<sub>1C</sub>) is a practical tool to assess long-term glucose control in the general population, it may underestimate glycemic control in chronic kidney disease (CKD) patients – especially those undergoing treatment with erythropoiesis-stimulating agents (ESA). We evaluated the association of HbA<sub>1C</sub> with other parameters of glucose homeostasis and tested its association with ESA use and mortality in nondiabetic incident dialysis patients. <i>Methods:</i> We studied 270 nondiabetic CKD stage 5 patients referred to initiate dialysis therapy [median age: 54 years (43–63), 154 males]. Patients were followed for up to 5 years for survival analysis. <i>Results: </i>HbA<sub>1C</sub> was positively correlated with age (Rho = 0.13; p = 0.031), C-reactive protein (Rho = 0.14; p = 0.024), total cholesterol (Rho = 0.19; p = 0.001), triglycerides (Rho = 0.21; p < 0.001) and glucose (Rho = 0.21; p = 0.001), but it was negatively correlated with HDL-cholesterol (Rho = –0.22; p < 0.001) and ESA dose (Rho = –0.27; p < 0.001). Across increasing HbA<sub>1C</sub> tertiles, increased glucose levels and reduced use of ESA and dose of ESA were observed (p < 0.001), but there were no differences in insulin and HOMA index. In a stepwise multivariate linear regression analysis, ESA dose was negatively associated with logHbA<sub>1C</sub>. HbA<sub>1C</sub> did not predict mortality. <i>Conclusion:</i> In nondiabetic CKD stage 5 patients, HbA<sub>1C</sub> levels were associated with ESA dose. HbA<sub>1C</sub> was not independently associated with surrogate markers of insulin resistance or mortality.