A high glycated albumin (GA) to glycated hemoglobin A1c (HbA1c) ratio is associated with increased risk of death within 3 years in patients with diabetes receiving dialysis.
The study was based on an analysis of data from 28,994 patients with diabetes receiving dialysis (female 32.9%; mean age 67.4 years). Mean dialysis vintage was 6.3 years.
Compared with a GA/HbA1c ratio of 3.0-3.3, the risk for all-cause mortality within 3 years was a significant 1.2- and 1.4-fold higher in patients with a GA/HbA1c ratio of 3.6-4.0 and more than 4.0, respectively, in adjusted analyses, Junichi Hoshino, MD, MPH, PhD, of the Japanese Society for Dialysis Therapy in Tokyo, Japan, and colleagues reported in Nephrology Dialysis Transplantation.
The risk for infection death within 3 years was a significant 1.2- and 1.5-fold higher in patients with a GA/HbA1c ratio of 3.6-4.0 and more than 4.0, respectively, compared with a GA/HbA1c ratio of 3.0-3.3. The risk for cardiovascular death within 3 years was a significant 1.2- and 1.4-fold higher in the groups with higher ratios compared with the reference group.
Propensity score matched analyses confirmed increased mortality risk among patients with a ratio of 3.3 or higher.
According to Dr Hoshino’s team, “the GA/A1c ratio was a very strong indicator of mortality independent of glycemic control, anemia and malnutrition.”
The investigators acknowledged the many diseases can affect the GA/HbA1c ratio. For example, a high ratio may be found in patients with liver cirrhosis, hypothyroidism, adrenal insufficiency, and other diseases that decrease protein synthesis.
“Although the interpretation of the GA/HbA1c ratio has not been fully clarified, our study suggests that the GA/HbA1c ratio may be a promising clinical marker for predicting survival in diabetic patients on dialysis.”
Hoshino J, Abe M, Hamano T, et al. Glycated albumin to glycated hemoglobin ratio and mortality in diabetic patients on dialysis: a new association. Nephrol Dial Transplant. Published online October 29, 2022. doi:10.1093/ndt/gfac297