Developing an HbA1c-based equation to estimate blood glucose in maintenance hemodialysis patients

Junichi Hoshino, Miklos Z. Molnar, Kunihiro Yamagata, Yoshifumi Ubara, Kenmei Takaichi, Csaba Kovesdy, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

OBJECTIVE-Hemoglobin A1c (HbA1c) has been widely used as a clinically important assessment tool for outcome analyses related to glycemic control. However, because of special conditions in dialysis patients, including the uremic milieu, there is no HbA1c blood glucose (BG) equation specific for patients on dialysis. In this study, we sought to develop HbA1c-BG equation models for hemodialysis patients. RESEARCH DESIGN AND METHODS-We examined associations between HbA1c and random serum BG over time in a contemporary cohort of diabetic patients with hemodialysis treated in DaVita dialysis clinics. We identified 11,986 patients (63±12 years old and 49%male) with 69,764 paired measurements of HbA1c and BG over the course of 5 years (2001-2006). Bootstrapping method was used to estimate average BG and corresponding HbA1c levels. The association was adjusted by patient factors using linear regression. RESULTSdLinear regression analyses yielded the following three regression equations: BG = 59.2 + 29.4 × HbA1c 2 20.8 × Alb (R2 = 0.483); BG = 104.8 + 29.7 × HbA1c 2 18.4 × Alb 2 4.7 × Hb (R2 = 0.486); and BG = 82.9 + 30.7 × HbA1c 2 16.5 × Alb 2 5.4 × Hb + 0.3 × age + race (R2 = 0.491). All our models showed stronger association than previous equation models (R 2 = 0.468 in the Diabetes Control and Complications Trial and A 1c-Derived Average Glucose equations). CONCLUSIONS-The association between HbA1c and BG in hemodialysis patients is different than that of patients with normal kidney function. Our analysis suggests that equations including serum albumin or hemoglobin are better for hemodialysis patients.

Original languageEnglish (US)
Pages (from-to)922-927
Number of pages6
JournalDiabetes care
Volume36
Issue number4
DOIs
StatePublished - Apr 1 2013

Fingerprint

Renal Dialysis
Blood Glucose
Hemoglobins
Maintenance
Dialysis
Diabetes Complications
Serum Albumin
Linear Models
Research Design
Regression Analysis
Outcome Assessment (Health Care)
Kidney
Glucose
Serum

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Hoshino, J., Molnar, M. Z., Yamagata, K., Ubara, Y., Takaichi, K., Kovesdy, C., & Kalantar-Zadeh, K. (2013). Developing an HbA1c-based equation to estimate blood glucose in maintenance hemodialysis patients. Diabetes care, 36(4), 922-927. https://doi.org/10.2337/dc12-1019

Developing an HbA1c-based equation to estimate blood glucose in maintenance hemodialysis patients. / Hoshino, Junichi; Molnar, Miklos Z.; Yamagata, Kunihiro; Ubara, Yoshifumi; Takaichi, Kenmei; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar.

In: Diabetes care, Vol. 36, No. 4, 01.04.2013, p. 922-927.

Research output: Contribution to journalArticle

Hoshino, J, Molnar, MZ, Yamagata, K, Ubara, Y, Takaichi, K, Kovesdy, C & Kalantar-Zadeh, K 2013, 'Developing an HbA1c-based equation to estimate blood glucose in maintenance hemodialysis patients', Diabetes care, vol. 36, no. 4, pp. 922-927. https://doi.org/10.2337/dc12-1019
Hoshino, Junichi ; Molnar, Miklos Z. ; Yamagata, Kunihiro ; Ubara, Yoshifumi ; Takaichi, Kenmei ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar. / Developing an HbA1c-based equation to estimate blood glucose in maintenance hemodialysis patients. In: Diabetes care. 2013 ; Vol. 36, No. 4. pp. 922-927.
@article{ddc8237d12794e50b4bf5bc6ce15cfdb,
title = "Developing an HbA1c-based equation to estimate blood glucose in maintenance hemodialysis patients",
abstract = "OBJECTIVE-Hemoglobin A1c (HbA1c) has been widely used as a clinically important assessment tool for outcome analyses related to glycemic control. However, because of special conditions in dialysis patients, including the uremic milieu, there is no HbA1c blood glucose (BG) equation specific for patients on dialysis. In this study, we sought to develop HbA1c-BG equation models for hemodialysis patients. RESEARCH DESIGN AND METHODS-We examined associations between HbA1c and random serum BG over time in a contemporary cohort of diabetic patients with hemodialysis treated in DaVita dialysis clinics. We identified 11,986 patients (63±12 years old and 49{\%}male) with 69,764 paired measurements of HbA1c and BG over the course of 5 years (2001-2006). Bootstrapping method was used to estimate average BG and corresponding HbA1c levels. The association was adjusted by patient factors using linear regression. RESULTSdLinear regression analyses yielded the following three regression equations: BG = 59.2 + 29.4 × HbA1c 2 20.8 × Alb (R2 = 0.483); BG = 104.8 + 29.7 × HbA1c 2 18.4 × Alb 2 4.7 × Hb (R2 = 0.486); and BG = 82.9 + 30.7 × HbA1c 2 16.5 × Alb 2 5.4 × Hb + 0.3 × age + race (R2 = 0.491). All our models showed stronger association than previous equation models (R 2 = 0.468 in the Diabetes Control and Complications Trial and A 1c-Derived Average Glucose equations). CONCLUSIONS-The association between HbA1c and BG in hemodialysis patients is different than that of patients with normal kidney function. Our analysis suggests that equations including serum albumin or hemoglobin are better for hemodialysis patients.",
author = "Junichi Hoshino and Molnar, {Miklos Z.} and Kunihiro Yamagata and Yoshifumi Ubara and Kenmei Takaichi and Csaba Kovesdy and Kamyar Kalantar-Zadeh",
year = "2013",
month = "4",
day = "1",
doi = "10.2337/dc12-1019",
language = "English (US)",
volume = "36",
pages = "922--927",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "4",

}

TY - JOUR

T1 - Developing an HbA1c-based equation to estimate blood glucose in maintenance hemodialysis patients

AU - Hoshino, Junichi

AU - Molnar, Miklos Z.

AU - Yamagata, Kunihiro

AU - Ubara, Yoshifumi

AU - Takaichi, Kenmei

AU - Kovesdy, Csaba

AU - Kalantar-Zadeh, Kamyar

PY - 2013/4/1

Y1 - 2013/4/1

N2 - OBJECTIVE-Hemoglobin A1c (HbA1c) has been widely used as a clinically important assessment tool for outcome analyses related to glycemic control. However, because of special conditions in dialysis patients, including the uremic milieu, there is no HbA1c blood glucose (BG) equation specific for patients on dialysis. In this study, we sought to develop HbA1c-BG equation models for hemodialysis patients. RESEARCH DESIGN AND METHODS-We examined associations between HbA1c and random serum BG over time in a contemporary cohort of diabetic patients with hemodialysis treated in DaVita dialysis clinics. We identified 11,986 patients (63±12 years old and 49%male) with 69,764 paired measurements of HbA1c and BG over the course of 5 years (2001-2006). Bootstrapping method was used to estimate average BG and corresponding HbA1c levels. The association was adjusted by patient factors using linear regression. RESULTSdLinear regression analyses yielded the following three regression equations: BG = 59.2 + 29.4 × HbA1c 2 20.8 × Alb (R2 = 0.483); BG = 104.8 + 29.7 × HbA1c 2 18.4 × Alb 2 4.7 × Hb (R2 = 0.486); and BG = 82.9 + 30.7 × HbA1c 2 16.5 × Alb 2 5.4 × Hb + 0.3 × age + race (R2 = 0.491). All our models showed stronger association than previous equation models (R 2 = 0.468 in the Diabetes Control and Complications Trial and A 1c-Derived Average Glucose equations). CONCLUSIONS-The association between HbA1c and BG in hemodialysis patients is different than that of patients with normal kidney function. Our analysis suggests that equations including serum albumin or hemoglobin are better for hemodialysis patients.

AB - OBJECTIVE-Hemoglobin A1c (HbA1c) has been widely used as a clinically important assessment tool for outcome analyses related to glycemic control. However, because of special conditions in dialysis patients, including the uremic milieu, there is no HbA1c blood glucose (BG) equation specific for patients on dialysis. In this study, we sought to develop HbA1c-BG equation models for hemodialysis patients. RESEARCH DESIGN AND METHODS-We examined associations between HbA1c and random serum BG over time in a contemporary cohort of diabetic patients with hemodialysis treated in DaVita dialysis clinics. We identified 11,986 patients (63±12 years old and 49%male) with 69,764 paired measurements of HbA1c and BG over the course of 5 years (2001-2006). Bootstrapping method was used to estimate average BG and corresponding HbA1c levels. The association was adjusted by patient factors using linear regression. RESULTSdLinear regression analyses yielded the following three regression equations: BG = 59.2 + 29.4 × HbA1c 2 20.8 × Alb (R2 = 0.483); BG = 104.8 + 29.7 × HbA1c 2 18.4 × Alb 2 4.7 × Hb (R2 = 0.486); and BG = 82.9 + 30.7 × HbA1c 2 16.5 × Alb 2 5.4 × Hb + 0.3 × age + race (R2 = 0.491). All our models showed stronger association than previous equation models (R 2 = 0.468 in the Diabetes Control and Complications Trial and A 1c-Derived Average Glucose equations). CONCLUSIONS-The association between HbA1c and BG in hemodialysis patients is different than that of patients with normal kidney function. Our analysis suggests that equations including serum albumin or hemoglobin are better for hemodialysis patients.

UR - http://www.scopus.com/inward/record.url?scp=84875460333&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84875460333&partnerID=8YFLogxK

U2 - 10.2337/dc12-1019

DO - 10.2337/dc12-1019

M3 - Article

VL - 36

SP - 922

EP - 927

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 4

ER -