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. 2013 Mar 15:418:73-6.
doi: 10.1016/j.cca.2012.12.022. Epub 2013 Jan 12.

Measurement of Hba(1C) in patients with chronic renal failure

Randie R Little  1 , Curt L Rohlfing, Alethea L Tennill, Steven E Hanson, Shawn Connolly, Trefor Higgins, Charles E Wiedmeyer, Cas W Weykamp, Richard Krause, William Roberts
Affiliations

Measurement of Hba(1C) in patients with chronic renal failure

Randie R Little et al. Clin Chim Acta. .

Abstract

Background: Carbamylated hemoglobin (carbHb) is reported to interfere with measurement and interpretation of HbA(1c) in diabetic patients with chronic renal failure (CRF). There is also concern that HbA1c may give low results in these patients due to shortened erythrocyte survival.

Methods: We evaluated the effect of carbHb on HbA(1c) measurements and compared HbA(1c) with glycated albumin (GA) in patients with and without renal disease to test if CRF causes clinically significant bias in HbA(1c) results by using 11 assay methods. Subjects included those with and without renal failure and diabetes. Each subject's estimated glomerular filtration rate (eGFR) was used to determine the presence and degree of the renal disease. A multiple regression model was used to determine if the relationship between HbA(1c) results obtained from each test method and the comparative method was significantly (p<0.05) affected by eGFR. These methods were further evaluated for clinical significance by using the difference between the eGRF quartiles of >7% at 6 or 9% HbA(1c). The relationship between HbA(1c) and glycated albumin (GA) in patients with and without renal failure was also compared.

Results: Some methods showed small but statistically significant effects of eGFR; none of these differences were clinically significant. If GA is assumed to better reflect glycemic control, then HbA(1c) was approximately 1.5% HbA(1c) lower in patients with renal failure.

Conclusions: Although most methods can measure HbA(1c) accurately in patients with renal failure, healthcare providers must interpret these test results cautiously in these patients due to the propensity for shortened erythrocyte survival in renal failure.

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Figures

Figure 1
Figure 1
Box plots of the residuals of the regression of HbA1c compared to the comparative method for the lowest and highest (shaded) eGFR quartiles. The horizontal line within each box is the median of the residuals. The upper and lower limits of each box correspond to the 25th and 75th percentile of the residuals. The highest and lowest whiskers represent the minimal and maximal residuals. Q1, lowest eGFR quartile; Q4, highest eGFR quartile.
Figure 2
Figure 2
Relationship between GA and HbA1c in patients with chronic renal failure (□, eGFR <60; —, y=3.51x − 4.88; r2=0.68) and without renal disease (■, eGFR>90; y=2.79x − 4.34; r2=0.83). Dotted horizontal and vertical lines indicate the difference in HbA1c between the two groups at a fixed GA.
See this image and copyright information in PMC

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