Glycated Albumin Versus HbA1c in the Evaluation of Glycemic Control in Patients With Diabetes and CKD

INTRODUCTION: It is inaccurate to assess blood glucose with glycated hemoglobin (HbA1c) in patients with diabetes and chronic kidney disease (CKD), and whether glycated albumin (GA) is better than HbA1c in these patients remains unclear. METHODS: We searched PubMed, Embase, Web of Science, Scopus, the Cochrane Library, and MEDLINE to July 2017 for studies that investigated the correlation between GA or HbA1c and the average glucose levels (AG) relevant to this theme. Statistical analysis was performed using RevMan5.3 and Stata12.0. The outcome was the correlation coefficient between GA or HbA1c and AG. For the first time, we made a comparison of GA and HbA1c in different CKD stages. RESULTS: A total of 24 studies with 3928 patients were included. Early stages of CKD refer to CKD stage 1 to 3. Advanced CKD refer to CKD stage 4 and 5 including patients receiving dialysis. The meta-analysis suggested that in early stages of CKD, the pooled R between GA and AG was 0.61 (95% CI = 0.49−0.73) and 0.71 (95% CI = 0.55−0.87) for HbA1c (P > 0.05). In advanced CKD patients, the pooled R between GA and AG was 0.57 (95% CI = 0.52−0.62), and 0.49 (95% CI = 0.45−0.52) for HbA1c (P = 0.0001). CONCLUSION: GA is superior to HbA1c in assessing blood glucose control in diabetes patients with advanced CKD.