Abstract
Background : To prevent the progression of diabetic complications, the treatment index of hemoglobin A1c (HbA1c) is less than 6.5% of the diabetic society guidelines. In patients undergoing hemodialysis, it has been reported that the HbA1c does not become an index because of shortened red blood cell survival, and that the red blood cell life span and the erythropoietin administered do not influence the glycated albumin (GA) and becomes a satisfactory index. We investigated the reliability of the target HbA1c value corrected by the erythropoietin dose as an index of long-term survival in these patients. Methods : HbA1c and GA were examined every month for a total of 290 times in 51 diabetic patients undergoing hemodialysis. We then evaluated the HbA1c value corrected by erythropoietin dose and GA measurement. The survival analysis based on the HbA1c measurements and on the erythropoietin-correctied HbA1c target value was performed in 96 diabetic patients receiving hemodialysis and both were compared from January 2000. Results : When there was no erythropoietin administration, the criterion GA level was 22.8% calculated by regression analysis from the guideline HbA1c data of 6.5%. Using the criterion of GA 22.8%, in the groups receiving erythropoietin administration, we suggest that the target HbA1c value corrected by the erythropoietin dose should be 5.7% (erythropoietin dose≤3,000 IU/week), 5.5% (≤6,000 IU/week) and 5.2% (≤9,000 IU/week) (p<0.0001). The survival rate was significantly favorable in patients remaining below the corrected HbA1c target value though there was no significant difference in the survival rate in the HbA1c measurements. Conclusions : It was thought that HbA1c was available as a sharp treatment target, and easily became an index of long-term survival if the correction by erythropoietin dose was added even in diabetic patients undergoing hemodialysis.
