Association of glycated albumin, but not glycated hemoglobin, with peripheral vascular calcification in hemodialysis patients with type 2 diabetes

Aims: Elevated HbA(1c) is a predictor of mortality as well as peripheral vascular calcification in hemodialysis (HD) patients with diabetes. However. improved glycemic control as reflected by reduction in HbA(1c) may dismiss the relationship between HbA(1c) and mortality in those patients, due possibly to the underestimation of HbA(1c) by erythropoietin use. This study was to establish the significance of glycated albumin (GA) as a useful marker of peripheral vascular calcification in diabetic HD patients, in comparison with HbA(1c). Main methods: We examined 49 HD patients with type 2 diabetes (37 men and 12 women). Peripheral vascular calcification at hand arteries was checked on a simple X-ray photograph. GA and HbA(1c) were determined just before HD session. Key findings: The prevalence of peripheral vascular calcification was significantly higher in diabetic patients (65.3%) than in non-diabetic patients (27.0%). Multiple regression analyses in diabetic patients showed that both HD duration and GA were significantly associated with the presence of peripheral vascular calcification. When CA was replaced by HbA(1c) in the same model, HbA(1c) failed to show a significant association. However, when a weekly dose of erythropoietin was simultaneously included in addition to HD duration and HbA(1c), both HbA(1c) as well as HD duration emerged as a significant factor associated with the presence of peripheral vascular calcification. Significance: The present study suggested that GA might be a better indicator of glycemic control, and raise the possibility that improvement of glycemic control might prevent against the development of peripheral vascular calcification in diabetic HD patients. (C) 2008 Published by Elsevier Inc.