Relationship between the accuracy of glycemic markers and the chronic kidney disease stage in patients with type 2 diabetes mellitus

Clin Nephrol. 2014 Aug;82(2):107-14. doi: 10.5414/CN108027.


Background: It is important to establish glycemic markers which reflect accurate glycemic status in advanced chronic kidney disease (CKD) patients; however, adequate glycemic markers have not been established. We evaluated the accuracy of glycemic markers in non-dialysis CKD patients.

Patients and methods: 139 non-dialysis CKD patients with diabetes were enrolled. The patients were divided into three groups as follows: group 1 (G1), patients with an estimated glomerular filtration rate (eGFR) >= 60 mL/min/1.73 m2; group 2 (G2), 30 ≤ eGFR < 60; and group 3 (G3), eGFR < 30. The patients were also classified by serum albumin: patients with serum albumin >= 3.5 g/dL as group S1 (S1) and serum albumin < 3.5 as group S2 (S2).

Results: Glycated hemoglobin (A1C) was positively correlated with random PG in G1 and G2; however, no significant correlation was observed in G3. Whereas glycated albumin (GA) was correlated with random PG in S1, there was no significant correlation in S2. To clarify the significance of A1C and GA, the relationships among A1C, GA, and various clinical parameters were examined. GA was correlated with serum albumin and the urinary albumin-creatinine ratio, whereas A1C was significantly correlated with hemoglobin, the dose of recombinant human erythropoietin, and eGFR.

Conclusion: A1C was affected by eGFR, and GA was influenced by hypoalbuminemia; therefore, it is necessary to choose adequate glycemic markers according to the CKD stage and serum albumin level. GA is a superior glycemic marker in patients with eGFR < 30 mL/min/1.73 m2 and serum albumin >= 3.5 g/dL.

MeSH terms

  • Aged
  • Albuminuria / diagnosis
  • Biomarkers / blood
  • Biomarkers / urine
  • Blood Glucose / analysis
  • Creatinine / urine
  • Diabetes Mellitus, Type 2 / blood*
  • Diabetic Nephropathies / blood*
  • Female
  • Glomerular Filtration Rate
  • Glycated Hemoglobin A / analysis
  • Humans
  • Male
  • Renal Insufficiency, Chronic / blood*
  • Serum Albumin / analysis


  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A
  • Serum Albumin
  • glycosylated serum albumin
  • hemoglobin A1c protein, human
  • Creatinine