A Critical Evaluation of Glycated Protein Parameters in Advanced Nephropathy: A Matter of Life or Death: Time to dispense with the hemoglobin A1C in end-stage kidney disease

Chronic kidney disease remains as one of the major complications for individuals with diabetes and contributes to considerable morbidity. Individuals subjected to dialysis therapy, half of whom are diabetic, experience a mortality of ∼20% per year. Understanding factors related to mortality remains...

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Main Author:	Freedman, Barry I.
Format:	Online
Language:	English
Published:	American Diabetes Association 2012
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3379614/

id	pubmed-3379614
recordtype	oai_dc
spelling	pubmed-33796142013-07-01 A Critical Evaluation of Glycated Protein Parameters in Advanced Nephropathy: A Matter of Life or Death: Time to dispense with the hemoglobin A1C in end-stage kidney disease Freedman, Barry I. Point-Counterpoint Chronic kidney disease remains as one of the major complications for individuals with diabetes and contributes to considerable morbidity. Individuals subjected to dialysis therapy, half of whom are diabetic, experience a mortality of ∼20% per year. Understanding factors related to mortality remains a priority. Outside of dialysis units, A1C is unquestioned as the “gold standard” for glycemic control. In the recent past, however, there is evidence in large cohorts of diabetic dialysis patients that A1C at both the higher and lower levels was associated with mortality. Given the unique conditions associated with the metabolic dysregulation in dialysis patients, there is a critical need to identify accurate assays to monitor glycemic control to relate to cardiovascular endpoints. In this two-part point-counterpoint narrative, Drs. Freedman and Kalantar-Zadeh take opposing views on the utility of A1C in relation to cardiovascular disease and survival and as to consideration of use of other short-term markers in glycemia. In the narrative below, Dr. Freedman suggests that glycated albumin may be the preferred glycemic marker in dialysis subjects. In the counterpoint narrative following Dr. Freedman’s contribution, Dr. Kalantar-Zadeh defends the use of A1C as the unquestioned gold standard for glycemic management in dialysis subjects. American Diabetes Association 2012-07 2012-06-12 /pmc/articles/PMC3379614/ /pubmed/22723586 http://dx.doi.org/10.2337/dc12-0027 Text en © 2012 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Freedman, Barry I.
spellingShingle	Freedman, Barry I. A Critical Evaluation of Glycated Protein Parameters in Advanced Nephropathy: A Matter of Life or Death: Time to dispense with the hemoglobin A1C in end-stage kidney disease
author_facet	Freedman, Barry I.
author_sort	Freedman, Barry I.
title	A Critical Evaluation of Glycated Protein Parameters in Advanced Nephropathy: A Matter of Life or Death: Time to dispense with the hemoglobin A1C in end-stage kidney disease
title_short	A Critical Evaluation of Glycated Protein Parameters in Advanced Nephropathy: A Matter of Life or Death: Time to dispense with the hemoglobin A1C in end-stage kidney disease
title_full	A Critical Evaluation of Glycated Protein Parameters in Advanced Nephropathy: A Matter of Life or Death: Time to dispense with the hemoglobin A1C in end-stage kidney disease
title_fullStr	A Critical Evaluation of Glycated Protein Parameters in Advanced Nephropathy: A Matter of Life or Death: Time to dispense with the hemoglobin A1C in end-stage kidney disease
title_full_unstemmed	A Critical Evaluation of Glycated Protein Parameters in Advanced Nephropathy: A Matter of Life or Death: Time to dispense with the hemoglobin A1C in end-stage kidney disease
title_sort	critical evaluation of glycated protein parameters in advanced nephropathy: a matter of life or death: time to dispense with the hemoglobin a1c in end-stage kidney disease
description	Chronic kidney disease remains as one of the major complications for individuals with diabetes and contributes to considerable morbidity. Individuals subjected to dialysis therapy, half of whom are diabetic, experience a mortality of ∼20% per year. Understanding factors related to mortality remains a priority. Outside of dialysis units, A1C is unquestioned as the “gold standard” for glycemic control. In the recent past, however, there is evidence in large cohorts of diabetic dialysis patients that A1C at both the higher and lower levels was associated with mortality. Given the unique conditions associated with the metabolic dysregulation in dialysis patients, there is a critical need to identify accurate assays to monitor glycemic control to relate to cardiovascular endpoints. In this two-part point-counterpoint narrative, Drs. Freedman and Kalantar-Zadeh take opposing views on the utility of A1C in relation to cardiovascular disease and survival and as to consideration of use of other short-term markers in glycemia. In the narrative below, Dr. Freedman suggests that glycated albumin may be the preferred glycemic marker in dialysis subjects. In the counterpoint narrative following Dr. Freedman’s contribution, Dr. Kalantar-Zadeh defends the use of A1C as the unquestioned gold standard for glycemic management in dialysis subjects.
publisher	American Diabetes Association
publishDate	2012
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3379614/
_version_	1611538194078105600

A Critical Evaluation of Glycated Protein Parameters in Advanced Nephropathy: A Matter of Life or Death: Time to dispense with the hemoglobin A1C in end-stage kidney disease

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