Dissociation of Glycated Albumin and HbA1c Is Associated With a Decline of Glomerular Filtration Rate as Evaluated by Inulin Clearance

Hemoglobin A1c (HbA1c), microalbuminuria, and estimated glomerular filtration rate (eGFR) are widely used for assessment of diabetic kidney disease (DKD). However, we have shown that eGFR is inaccurate in DKD (1). Further, HbA1c has several limitations as a glycemic marker (2). Guidelines for hemodialysis patients in Japan recommend evaluation of glycemic control using glycated albumin (GA) rather than HbA1c, which is affected by conditions such as anemia and renal failure (3). Renal anemia is a common complication in chronic kidney disease (CKD), including in predialysis patients with CKD. Thus, we evaluated the correlations between GFR measured accurately by inulin clearance (Cin) and the dissociation of GA and HbA1c in nondialysis patients with CKD. The study protocol was approved by the Ethics Committee of Osaka City University Graduate School of Medicine (#3506) as an opt-out study. The study was performed between January 2009 and March 2020 at Osaka City University Hospital. The subjects were 133 patients (60.6 ± 12.5 years, 66 males) with glycemic disorder. Diagnosis of type 2 diabetes (87 subjects) was based on a history of diabetes or criteria in the “Report of the Expert Committee on the …