Serum Fructosamine and Glycated Albumin and Risk of Mortality and Clinical Outcomes in Hemodialysis Patients

• Type of Material: Article
• Authors: Tariq Shafi, Johns Hopkins University; Stephen M. Sozio, Johns Hopkins University; Laura Plantinga, Emory University; Bernard G. Jaar, Johns Hopkins University; Edward T. Kim, Diablo Nephrology Medical Group; Rulan S. Parekh, Johns Hopkins University; Michael W. Steffes, University of Minnesota; Neil R. Powe, Johns Hopkins University; Josef Coresh, Johns Hopkins University; Elizabeth Selvin, Johns Hopkins University
• Language: English
• Date: 2013-06-01
• Publisher: AMER DIABETES ASSOC
• Publication Version: Final Published Version
• Copyright Statement: © 2013 by the American Diabetes Association.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.2337/dc12-1896
• Title of Journal or Parent Work: DIABETES CARE
• Volume: 36
• Issue: 6
• Start Page: 1522
• End Page: 1533
• Grant/Funding Information: CHOICE was supported by the Agency for Healthcare Quality and Research (R01-HS-008365 from July 1994 to June 1999); by the National Heart, Lung, and Blood Institute (RO1-HL-62985 from September 2000 to June 2006); and by the National Institute of Diabetes and Digestive and Kidney Diseases (R01-DK-059616 from September 2000 to June 2005 and R01-DK-080123 from August 2008 to June 2013). T.S. was supported by K23-DK-083514 and the National Kidney Foundation of Maryland Professional Development Award. R.S.P. was supported by R01-DK-072367. J.C. was supported in part by an American Heart Association Established Investigator Award (01-4019-7N). N.R.P. was supported in part by K24-DK-02643 and R01-DK-080123. E.S. was supported by R01-DK-089174.
• Keywords: Life Sciences & Biomedicine; KIDNEY-DISEASE; GLYCEMIC CONTROL; SURVIVAL; DIABETIC DIALYSIS PATIENTS; STAGE RENAL-DISEASE; Science & Technology; PROTEIN PARAMETERS; ADVANCED NEPHROPATHY; DEATH; HEMOGLOBIN A(1C); PERITONEAL; Endocrinology & Metabolism
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery; Biology, Cell

Abstract

OBJECTIVE - Assays for serum total glycated proteins (fructosamine) and the more specific glycated albumin may be useful indicators of hyperglycemia in dialysis patients, either as substitutes or adjuncts to standard markers such as hemoglobin A1c, as they are not affected by erythrocyte turnover. However, their relationship with long-termoutcomes in dialysis patients is not well described. RESEARCH DESIGN AND METHODS - We measured fructosamine and glycated albumin in baseline samples from 503 incident hemodialysis participants of a national prospective cohort study, with enrollment from 1995-1998 and median follow-up of 3.5 years. Outcomes were all-cause and cardiovascular disease (CVD) mortality and morbidity (first CVD event and first sepsis hospitalization) analyzed using Cox regression adjusted for demographic and clinical characteristics, and comorbidities. RESULTS - Mean age was 58 years, 64% were white, 54% were male, and 57% had diabetes. There were 354 deaths (159 from CVD), 302 CVD events, and 118 sepsis hospitalizations over follow-up. Both fructosamine and glycated albumin were associated with all-cause mortality; adjusted HR per doubling of the biomarker was 1.96 (95% CI 1.38 - 2.79) for fructosamine and 1.40 (1.09- 1.80) for glycated albumin. Both markers were also associated with CVD mortality [fructosamine 2.13 (1.28 - 3.54); glycated albumin 1.55 (1.09 - 2.21)]. Higher values of both markers were associated with trends toward a higher risk of hospitalization with sepsis [fructosamine 1.75 (1.01-3.02); glycated albumin 1.39 (0.94-2.06)]. CONCLUSIONS - Serum fructosamine and glycated albumin are risk factors for mortality and morbidity in hemodialysis patients.