High glycated albumin levels tied to risk of CVD and death in advanced-stage diabetic kidney disease patients

Higher levels of HbA1c (haemoglobin A1c), the gold standard indicator of glycemic control, predicted all-cause and cardiovascular mortality in diabetes patients undergoing chronic hemodialysis. However, in patients with advanced-stage diabetic kidney disease (DKD), HbA1c values are underestimated due to unpredictable changes in the survival time of erythrocytes, leading to the unreliability of the HbA1c values.

Glycated albumin indicating average glucose levels during the preceding 2 to 3 weeks is preferable to HbA1c for evaluating glycemic control in chronic hemodialysis patients with diabetes because the erythrocytes' life span does not impact GA levels.

Previous studies have shown glycated albumin to be a more accurate measure of short-term blood sugar control in dialysis patients. Therefore, Huilei Zhao, The Third Hospital of Nanchang, Nanchang, China, and colleagues aimed to determine the relationship between GA and the risk of mortality and cardiovascular diseases in patients with and without dialysis.

For this purpose, the researchers searched cohort studies of associations between GA level and cardiovascular disease and mortality in online databases. The random effects model summarized the effect size, and the robust error meta-regression method determined the dose-response association.

Data from 17 cohort studies were included (12 were prospective and five were retrospective) comprising 80 024 participants.

The authors reported the following findings:

• Higher levels of GA were associated with increased risk of CV mortality [hazard ratio = 1.90], all-cause mortality (hazard ratio = 1.64), major adverse cardio-cerebral events (risk ratio = 1.41), coronary artery disease (odds ratio = 2.24) and stroke (risk ratio = 1.72).
• The dose-response analysis showed that GA levels were positively and linearly associated with the risk of CV mortality, all-cause mortality and coronary artery disease.
• Subgroup analysis revealed that high levels of GA were associated with the risk of CV and all-cause mortality, regardless of dialysis status, with significant differences between subgroups of dialysis.

"Our findings showed that high glycated albumin levels are linked with an increased risk of CVDs and mortality, regardless of dialysis status," the researchers concluded.

Reference:

Zhao, Huilei, et al. "Glycated Albumin and Risk of Cardiovascular Diseases and Mortality in Patients With and Without Dialysis: a Meta-analysis." Diabetes, Obesity & Metabolism, 2023.