HbA1c reliability in patients with diabetes on regular hemodialysis before and after erythropoietin therapy

Abstract

PurposeThe purpose of this study was to determine the effect of erythropoietin (EPO) treatment on HbA1c levels in diabetic patients on regular hemodialysis and to assess the reliability of HbA1c as a marker for glycemic control in such patients. MethodsThe study included 41 patients on regular hemodialysis who were EPO naive: 31 with diabetes mellitus and 10 nondiabetic controls. Baseline HBA1c and fasting blood glucose levels were measured and repeated after a 3-month course of EPO. Results HbA1c decreased significantly after EPO therapy (P=0.01) and was associated with a significant decline in fasting blood glucose levels (P=0.001), with a significant negative correlation with hemoglobin (r=-0.185, P=0.03). HbA1c showed significant correlation with fasting blood glucose in diabetic patients before EPO therapy (r=0.82, P<0.0001). This correlation was found to be independent of other laboratory parameters. No correlation was found between HbA1c and fasting blood glucose levels after 3 months of EPO treatment. Conclusion HbA1c is not a reliable marker for glycemic control in hemodialysis patients, especially for those on EPO therapy.

Keywords

• diabetes mellitus, end-stage renal disease, erythropoietin, HbA1c