| Objectives: Anemia and hemoglobin(Hb)derivatives have been reported to interfere with the measurement and interpretation of HbA1c in patients.The aim of this study was to analyze whether HbA1c levels in patients with chronic kidney disease(CKD)can truly assess their blood glucose levels and to analyze the reasons that lead to the creation of interference.Methods: 190 patients with CKD who were seen in the nephrology department of a hospital during May 2020-November 2022 and met the inclusion and exclusion criteria were used as the case group and 72 normal people as healthy as the control group.The e GFR of CKD patients was calculated according to the modified Chinese MDRD formula and divided into 75 cases in the CKD stage 2~4 group and 115 cases in the uremic group.Query basic clinical information related to the patient from the hospital electronic system,including name,gender,age,discharge diagnosis,history of anemia treatment,history of blood transfusion,hemodialysis and peritoneal dialysis(including dialysis duration,frequency and specific protocol.Laboratory tests were recorded,including routine blood,renal function,fasting blood glucose,and HbA1c values.Fasting plasma glucose(FPG)readings were used as controls to analyze whether the FPG and HbA1c levels matched between the control group,CKD stage 2~4 group and CKD stage 5 group,i.e.,whether there was a difference in HbA1c between groups at the same level of FPG;and whether there was a difference in HbA1c by urea,Hb and red blood cell specific volume(HCT)levels,and analyze the differences between FPG and HbA1c levels among the groups;establish a stepwise regression linear model to analyze the effect of FPG,Hb and HCT on the changes of HbA1c levels;group the patients with CKD stage 5 on hemodialysis(HD),peritoneal dialysis(PD)and no dialysis groups,and analyzed the difference of FPG and HbA1c levels between the groups.Results: FPG was not statistically different between the control,CKD stage 2~4 and CKD stage 5 groups(P > 0.05).HbA1c was not statistically different between the control and CKD stage 2~4 groups(P > 0.05);HbA1c levels were higher in the control group than in the CDK stage 5 group by about 0.29%(95% IC: 0.183-0.405),P < 0.001;HbA1c levels were higher in the CKD stage 2~4 group than in the CDK stage 5 group by about 0.31%(95% IC: 0.195-0.414),P < 0.001.The HbA1c level in the CKD stage 2~4 group was higher than that in the CDK5 group by about 0.31%(95%IC: 0.195-0.414),P < 0.001.The difference in HbA1c between the hyperuremic and urea-normal groups was not significant(P > 0.05).There was no significant difference between the dialysis groups(P > 0.05).The HbA1c level in the HB1(Hb > 143 g/L)group was higher than that in the HB4(Hb ≤ 98 g/L)group 0.396%(95% IC: 0.268-0.523),P < 0.001.The HbA1c level in the HCT1(HCT>0.430 l/L)group was higher than that in the HCT4(HCT≤0.303 l/L)group by 0.392%(95% IC: 0.261-0.523),(P < 0.001).The results of multiple stepwise regression analysis in the control group were: the effect of each variable on the dependent variable HbA1c in the order of FPG > HCT > Hb;the results of multiple stepwise regression analysis in the CKD group were: the effect of each variable on the dependent variable HbA1c in the order of HCT > FPG,and the independent variable Hb was not significant.Conclusions:1.HbA1c levels are significantly lower in patients with CKD5 than in the normal population.HbA1c is inaccurate in the CKD5 population and should be used in conjunction with other indicators of glucose metabolism such as FPG and OGTT and anaemia is the main cause of this interference,with the more severe the anaemia the lower the HbA1c level.2.High urea levels do not interfere with immunoturbidimetry,but in people with CKD,the same measurement should always be used when monitoring HbA1c levels to ensure that longitudinally comparable readings are produced.3.Haemodialysis and peritoneal dialysis do not interfere with HbA1c levels,but further studies are needed to support this conclusion. |
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