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1
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Abe M, Matsuoka T, Kawamoto S, Miyasato K, Kobayashi H. Toward Revision of the ‘Best Practice for Diabetic Patients on Hemodialysis 2012’. KIDNEY AND DIALYSIS 2022; 2:495-511. [DOI: 10.3390/kidneydial2040045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
Diabetic nephropathy is the leading cause of dialysis therapy worldwide. The number of diabetes patients on dialysis in clinical settings has been increasing in Japan. In 2013, the Japanese Society for Dialysis Therapy (JSDT) published the “Best Practice for Diabetic Patients on Hemodialysis 2012”. While glycated hemoglobin (HbA1c) is used mainly as a glycemic control index for dialysis patients overseas, Japan is the first country in the world to use glycated albumin (GA) for assessment. According to a survey conducted by the JSDT in 2018, the number of facilities measuring only HbA1c has decreased compared with 2013, while the number of facilities measuring GA or both has significantly increased. Ten years have passed since the publication of the first edition of the guidelines, and several clinical studies regarding the GA value and mortality of dialysis patients have been reported. In addition, novel antidiabetic agents have appeared, and continuous glucose monitoring of dialysis patients has been adopted. On the other hand, Japanese dialysis patients are rapidly aging, and the proportion of patients with malnutrition is increasing. Therefore, there is great variation among diabetes patients on dialysis with respect to their backgrounds and characteristics. This review covers the indices and targets of glycemic control, the treatment of hyperglycemia, and diet recommendations for dialysis patients with diabetes.
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Affiliation(s)
- Masanori Abe
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Tomomi Matsuoka
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Shunsuke Kawamoto
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Kota Miyasato
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Hiroki Kobayashi
- Division of Nephrology, Hypertension and Endocrinology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
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Miyawaki J, Okuno S, Mori K, Nishio E, Norimine K, Kurajoh M, Yamakawa T, Shoji S, Inaba M. Inverse association of fat mass, but not lean mass, with glycated albumin in hemodialysis patients with or without diabetes mellitus. Ren Fail 2019; 41:808-813. [PMID: 31498022 PMCID: PMC6746297 DOI: 10.1080/0886022x.2019.1659819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Glycated albumin (GA), which is independent of anemia and/or use of erythropoiesis-stimulating agents, might provide a more precise measure than glycated hemoglobin (HbA1c) in hemodialysis patients. The present study examines whether body composition is associated with GA besides glycemic control in hemodialysis patients. Methods: This study included 90 hemodialysis patients with diabetes mellitus (DM) and 86 hemodialysis patients without DM. We examined blood parameters after an overnight fast and body fat and lean mass using dual X-ray absorptiometry 21–24 h after completing the dialysis session. Results: The mean body mass index (BMI) was 22.0 kg/m2. BMI and truncal fat mass were significantly higher, and total fat mass tended to be higher in hemodialysis patients with DM than in those without DM. GA exhibited inverse correlations with BMI, total lean mass, total fat mass, and truncal fat mass in hemodialysis patients with and without DM; however, there was a lack of correlation with total lean mass in patients without DM. In multiple regression analysis including total fat mass and total lean mass simultaneously as independent variables, total fat mass (with DM: β = –0.322, p = .006) (without DM: β = –0.391, p < .001), but not total lean mass, in addition to log fasting plasma glucose, emerged as an independent factor associated with GA in hemodialysis patients with and without DM. When total fat mass was replaced with truncal fat mass (with DM: β = –0.311, p = .007) (without DM: β = –0.396, p < .001), the association remained significant and independent with GA in both patient groups. Conclusions: Higher total fat mass, particularly truncal fat mass, might be associated with lower GA levels, beside glycemic control, in hemodialysis patients with or without DM.
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Affiliation(s)
| | - Senji Okuno
- Kidney Center, Shirasagi Hospital , Osaka , Japan
| | - Katsuhito Mori
- Department of Nephrology, Osaka City University Graduate School of Medicine , Osaka , Japan
| | - Eriko Nishio
- Kidney Center, Shirasagi Hospital , Osaka , Japan
| | | | - Masafumi Kurajoh
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine , Osaka , Japan
| | | | | | - Masaaki Inaba
- Department of Nephrology, Osaka City University Graduate School of Medicine , Osaka , Japan.,Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine , Osaka , Japan
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Miyabe M, Kurajoh M, Mori K, Okuno S, Okada S, Emoto M, Tsujimoto Y, Inaba M. Superiority of glycated albumin over glycated haemoglobin as indicator of glycaemic control and predictor of all-cause mortality in patients with type 2 diabetes mellitus receiving peritoneal dialysis. Ann Clin Biochem 2019; 56:684-691. [PMID: 31411048 DOI: 10.1177/0004563219873688] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Glycated albumin, in contrast to glycated haemoglobin, precisely reflects glycaemic control and predicts all-cause mortality in haemodialysis patients with diabetes mellitus. However, whether those associations exist in diabetes mellitus patients receiving peritoneal dialysis remains unclear. Methods This was a retrospective cross-sectional and longitudinal observational study. We measured glycated albumin, glycated haemoglobin and casual plasma glucose for two months in diabetes mellitus-peritoneal dialysis ( n = 44) and diabetes mellitus-haemodialysis ( n = 88) patients (age-, gender-matched). The diabetes mellitus-peritoneal dialysis patients were followed for three years to monitor occurrence of all-cause mortality. Results Glycated albumin and glycated albumin/casual plasma glucose ratios, but not casual plasma glucose, glycated haemoglobin, or glycated haemoglobin/casual plasma glucose, were significantly lower in the diabetes mellitus-peritoneal dialysis as compared with the diabetes mellitus-haemodialysis patients. The regression lines between casual plasma glucose and glycated albumin showed a significant parallel shift downwards in diabetes mellitus-peritoneal dialysis as compared with diabetes mellitus-haemodialysis patients, while the slope did not differ significantly between the groups, resulting in underestimation of glycaemic control by 4.5%. Kapan-Meier analysis of the diabetes mellitus-peritoneal dialysis patients revealed that higher glycated albumin (median >18.0%), but not glycated haemoglobin (median >6.6%), indicated significantly elevated risk for all-cause mortality, which occurred in 15 patients (34.1%), as compared with those with a lower glycated albumin concentration. Higher glycated albumin concentration was also significantly and independently associated with all-cause mortality in multivariate Cox proportional hazards analysis. Conclusions Glycated albumin, in contrast to glycated haemoglobin, more precisely reflects glycaemic control in diabetes mellitus-peritoneal dialysis patients, based on its significant association with all-cause mortality. Furthermore, adjustment of the true glycated albumin concentration by adding 4.5% might provide a more precise measurement for determining glycaemic control in such patients.
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Affiliation(s)
- Mizuki Miyabe
- Division of Internal Medicine, Dialysis Center, Inoue Hospital, Osaka, Japan.,Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masafumi Kurajoh
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Katsuhito Mori
- Department of Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Senji Okuno
- Shirasagi Hospital, Division of Internal Medicine, Osaka, Japan
| | - Shigeki Okada
- Okada Clinic, Division of Dialysis Center, Osaka, Japan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yoshihiro Tsujimoto
- Division of Internal Medicine, Dialysis Center, Inoue Hospital, Osaka, Japan
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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Abe M, Hamano T, Hoshino J, Wada A, Nakai S, Masakane I. Glycemic control and survival in peritoneal dialysis patients with diabetes: A 2-year nationwide cohort study. Sci Rep 2019; 9:3320. [PMID: 30824808 PMCID: PMC6397316 DOI: 10.1038/s41598-019-39933-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/04/2019] [Indexed: 12/21/2022] Open
Abstract
For glycemic control in patients with diabetes on peritoneal dialysis (PD), the level of glycated albumin (GA) associated with mortality is unclear. Accordingly, we examined the difference in the association of GA and glycated hemoglobin (HbA1c) with 2-year mortality in a Japanese Society for Dialysis Therapy cohort. We examined 1601 patients with prevalent diabetes who were on PD. Of these, 1282 had HbA1c (HbA1c cohort) and 725 had GA (GA cohort) measured. We followed them for 2 years from 2013 to 2015 and used Cox regression to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for 2-year mortality after adjusting for potential confounders in each cohort. No significant association was found between HbA1c levels and all-cause death HRs before and after adjustment for confounders in the HbA1c cohort. In contrast, the adjusted all-cause death HRs and 95% CIs for GAs < 12.0%, 12.0–13.9%, 16.0–17.9%, 18.0–19.9%, 20.0–21.9%, and ≥22.0%, compared with 14.0–15.9% (reference), were 1.56 (0.32–7.45), 1.24 (0.32–4.83), 1.32 (0.36–4.77), 2.02 (0.54–7.53), 4.36 (1.10–17.0), and 4.10 (1.20–14.0), respectively. In the GA cohort, GA ≥ 20.0% was significantly associated with a higher death HR compared with the reference GA. Thus, GA ≥ 20.0% appears to be associated with a decrease in survival in diabetic patients on PD. There were no associations between HbA1c levels and 2-year mortality in PD patients.
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Affiliation(s)
- Masanori Abe
- The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan. .,Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Takayuki Hamano
- The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Junichi Hoshino
- The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Atsushi Wada
- The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Department of Nephrology, Kitasaito Hospital, Asahikawa, Japan
| | - Shigeru Nakai
- The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Department of Clinical Engineering, Fujita Health University, Aichi, Japan
| | - Ikuto Masakane
- The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Yabuki Hospital, Yamagata, Japan
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Abe M, Hamano T, Hoshino J, Wada A, Nakai S, Masakane I. Rate of the "burnt-out diabetes" phenomenon in patients on peritoneal dialysis. Diabetes Res Clin Pract 2018; 143:254-262. [PMID: 30056189 DOI: 10.1016/j.diabres.2018.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/14/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
AIMS In some diabetes patients on dialysis, glycemic control improves spontaneously, leading to normal HbA1c levels; this phenomenon is known as "burnt-out diabetes." Glycated albumin (GA) might be a better indicator of glycemic control than HbA1c in hemodialysis patients, but it has not been assessed in peritoneal dialysis (PD) patients. METHODS This study involved diabetes patients on PD, with HbA1c level and antidiabetes therapy records. First, the "burnt-out diabetes" phenomenon was investigated in patients with HbA1c measurements alone (HbA1c cohort). Then, it was investigated in patients with both HbA1c and GA measurements (GA cohort). RESULTS A total of 1296 patients were included in the HbA1c cohort. When "burnt-out diabetes" was defined as HbA1c < 6.0% without treatment, it was noted in 269 patients (20.8%). A total of 413 patients were subsequently included in the GA cohort. "Burnt-out diabetes," using the same definition, was found in 73 patients (17.7%). However, when defined as HbA1c < 6.0% and GA < 16.0% without treatment, "burnt-out diabetes" was found in 45 patients (10.9%). CONCLUSIONS Although the "burnt-out diabetes" phenomenon was present in 17.7% of patients with diabetes on PD based on HbA1c, the rate was significantly decreased to 10.9% when taking GA into account.
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Affiliation(s)
- Masanori Abe
- JSDT Renal Data Registry Committee (JRDR Committee), Japanese Society for Dialysis Therapy (JSDT), Tokyo, Japan; Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Takayuki Hamano
- JSDT Renal Data Registry Committee (JRDR Committee), Japanese Society for Dialysis Therapy (JSDT), Tokyo, Japan; Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Junichi Hoshino
- JSDT Renal Data Registry Committee (JRDR Committee), Japanese Society for Dialysis Therapy (JSDT), Tokyo, Japan; Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Atsushi Wada
- JSDT Renal Data Registry Committee (JRDR Committee), Japanese Society for Dialysis Therapy (JSDT), Tokyo, Japan; Department of Nephrology, Kitasaito Hospital, Asahikawa, Japan
| | - Shigeru Nakai
- JSDT Renal Data Registry Committee (JRDR Committee), Japanese Society for Dialysis Therapy (JSDT), Tokyo, Japan; Department of Clinical Engineering, Fujita Health University, Aichi, Japan
| | - Ikuto Masakane
- JSDT Renal Data Registry Committee (JRDR Committee), Japanese Society for Dialysis Therapy (JSDT), Tokyo, Japan; Yabuki Hospital, Yamagata, Japan
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Dozio E, Corradi V, Proglio M, Vianello E, Menicanti L, Rigolini R, Caprara C, de Cal M, Corsi Romanelli MM, Ronco C. Usefulness of glycated albumin as a biomarker for glucose control and prognostic factor in chronic kidney disease patients on dialysis (CKD-G5D). Diabetes Res Clin Pract 2018; 140:9-17. [PMID: 29596954 DOI: 10.1016/j.diabres.2018.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/08/2018] [Indexed: 12/17/2022]
Abstract
In chronic kidney disease patients on dialysis (CKD-G5D) accurate assessment of glycemic control is vital to improve their outcome and survival. The best glycemic marker for glucose control in these patients is still debated because several clinical and pharmacological factors may affect the ability of the available biomarkers to reflect the patient's glycemic status properly. This review discusses the role of glycated albumin (GA) both as a biomarker for glucose control and as a prognostic factor in CKD-G5D; it also looks at the pros and cons of GA in comparison to the other markers and its usefulness in hemodialysis and peritoneal dialysis.
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Affiliation(s)
- Elena Dozio
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy.
| | - Valentina Corradi
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
| | - Marta Proglio
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy
| | - Elena Vianello
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy
| | - Roberta Rigolini
- Service of Laboratory Medicine1-Clinical Pathology, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy
| | - Carlotta Caprara
- International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
| | - Massimiliano M Corsi Romanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy; Service of Laboratory Medicine1-Clinical Pathology, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
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7
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Yajima T, Yajima K, Hayashi M, Yasuda K, Takahashi H, Yamakita N. Serum albumin-adjusted glycated albumin is a better predictor of mortality in diabetic patients with end-stage renal disease on hemodialysis. J Diabetes Complications 2016; 30:786-9. [PMID: 27009773 DOI: 10.1016/j.jdiacomp.2016.02.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 11/30/2022]
Abstract
AIMS Glycated albumin (GA) is a marker for monitoring glycemic control in diabetic patients with end-stage renal disease (ESRD). We evaluated whether serum albumin-adjusted GA (adjusted GA) could predict mortality in diabetic patients with ESRD on hemodialysis. METHODS Seventy-eight patients with type 2 diabetes treated with regular hemodialysis were enrolled and followed up for 5-years. The adjusted GA was calculated from the regression formula and mean GA. The cut-off values for GA and adjusted GA that predicted mortality risk were determined using receiver operating characteristic curve analysis. RESULTS During the follow-up period (median: 36months), 15 patients died. In the Kaplan-Meier analysis, there were no significant differences in the 5-year cumulative survival rate (58.3% [GA ≥19.8%] vs. 88.6% [GA <19.8%], P=0.075). Conversely, this rate was significantly higher in patients with adjusted GA <21.2% than adjusted GA ≥21.2% (86.4 vs. 49.5%, P=0.0068). After adjustment for other confounders, adjusted GA ≥21.2% was an independent predictor for mortality (hazard ratio 3.76, 95% confidence interval 1.12-17.44, P=0.031), but GA ≥19.8% was not (hazard ratio 2.63, 95% confidence interval 0.65-17.69, P=0.19). CONCLUSIONS Adjusted GA is a better predictor of mortality than GA in diabetic patients with ESRD on hemodialysis.
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MESH Headings
- Aged
- Algorithms
- Biomarkers/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/therapy
- Diabetic Nephropathies/blood
- Diabetic Nephropathies/mortality
- Diabetic Nephropathies/therapy
- Female
- Follow-Up Studies
- Glycated Hemoglobin/analysis
- Glycation End Products, Advanced
- Hospitals, General
- Humans
- Japan/epidemiology
- Kidney Failure, Chronic/blood
- Kidney Failure, Chronic/complications
- Kidney Failure, Chronic/mortality
- Kidney Failure, Chronic/therapy
- Male
- Middle Aged
- Mortality
- Outpatient Clinics, Hospital
- Prospective Studies
- ROC Curve
- Renal Dialysis/adverse effects
- Serum Albumin/analysis
- Serum Albumin, Human/analysis
- Survival Analysis
- Glycated Serum Albumin
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Affiliation(s)
- Takahiro Yajima
- Department of Nephrology, Matsunami General Hospital, Gifu 501-6062, Japan.
| | - Kumiko Yajima
- Department of Internal Medicine, Matsunami General Hospital, Gifu 501-6062, Japan
| | - Makoto Hayashi
- Department of Internal Medicine, Matsunami General Hospital, Gifu 501-6062, Japan
| | - Keigo Yasuda
- Department of Internal Medicine, Matsunami General Hospital, Gifu 501-6062, Japan
| | - Hiroshi Takahashi
- Division of Medical Statistics, Fujita Health University School of Medicine, Aichi 470-1192, Japan
| | - Noriyoshi Yamakita
- Department of Internal Medicine, Matsunami General Hospital, Gifu 501-6062, Japan
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Switching from subcutaneous insulin injection to oral vildagliptin administration in hemodialysis patients with type 2 diabetes: a pilot study. Int Urol Nephrol 2016; 48:1349-1355. [DOI: 10.1007/s11255-016-1305-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 04/23/2016] [Indexed: 02/08/2023]
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Successful glycemic control with three times a week degludec injection by medical staff for an elderly hemodialysis patient with type 2 diabetes. Diabetol Int 2016; 7:95-99. [DOI: 10.1007/s13340-015-0220-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
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Fukami K, Shibata R, Nakayama H, Yamada K, Okuda S, Koga M. Serum albumin-adjusted glycated albumin reflects glycemic excursion in diabetic patients with severe chronic kidney disease not treated with dialysis. J Diabetes Complications 2015; 29:913-7. [PMID: 26164356 DOI: 10.1016/j.jdiacomp.2015.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Diabetic patients with severe chronic kidney disease (CKD) not treated with dialysis falsely show low levels of HbA1c and GA due to renal anemia and proteinuria, respectively. Recently, we reported that serum albumin-adjusted GA (adjGA) accurately reflects mean plasma glucose (PG) in these patients. It is considered that GA reflects not only mean PG but also glycemic excursion; therefore, in the present study we investigated whether adjGA reflects glycemic excursion in these patients. METHODS Thirty type 2 diabetic patients with severe CKD not treated with dialysis were enrolled in the present study. PG was monitored by seven times a day, and indicators of glycemic excursion [SD, max PG, ΔPG, M value, J index, and mean amplitude of glucose excursion (MAGE)] were calculated. The correlations between HbA1c, GA or adjGA and indicators of glycemic excursion were investigated. RESULTS HbA1c showed no significant correlation with indicators of glycemic excursion. GA was significantly correlated with them except for ΔPG. adjGA was significantly and strongly associated with them except for MAGE. GA, but not adjGA, showed a significant positive correlation with serum albumin. CONCLUSION adjGA was not influenced by serum albumin and showed a significant correlation with indicators of glycemic excursion in diabetic patients with severe CKD not treated with dialysis. These results suggest that adjGA could be useful for indicating glycemic control in diabetic patients with severe CKD not treated with dialysis.
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Affiliation(s)
- Kei Fukami
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan
| | - Ryo Shibata
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan
| | - Hitomi Nakayama
- Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan
| | - Kentaro Yamada
- Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan
| | - Seiya Okuda
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan
| | - Masafumi Koga
- Department of Internal Medicine, Kawanishi City Hospital, Hyogo 666-0915, Japan.
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Nakamura Y, Hasegawa H, Tsuji M, Udaka Y, Mihara M, Shimizu T, Inoue M, Goto Y, Gotoh H, Inagaki M, Oguchi K. Diabetes therapies in hemodialysis patients: Dipeptidase-4 inhibitors. World J Diabetes 2015; 6:840-9. [PMID: 26131325 PMCID: PMC4478579 DOI: 10.4239/wjd.v6.i6.840] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 03/16/2015] [Accepted: 04/01/2015] [Indexed: 02/05/2023] Open
Abstract
Although several previous studies have been published on the effects of dipeptidase-4 (DPP-4) inhibitors in diabetic hemodialysis (HD) patients, the findings have yet to be reviewed comprehensively. Eyesight failure caused by diabetic retinopathy and aging-related dementia make multiple daily insulin injections difficult for HD patients. Therefore, we reviewed the effects of DPP-4 inhibitors with a focus on oral antidiabetic drugs as a new treatment strategy in HD patients with diabetes. The following 7 DPP-4 inhibitors are available worldwide: sitagliptin, vildagliptin, alogliptin, linagliptin, teneligliptin, anagliptin, and saxagliptin. All of these are administered once daily with dose adjustments in HD patients. Four types of oral antidiabetic drugs can be administered for combination oral therapy with DPP-4 inhibitors, including sulfonylureas, meglitinide, thiazolidinediones, and alpha-glucosidase inhibitor. Nine studies examined the antidiabetic effects in HD patients. Treatments decreased hemoglobin A1c and glycated albumin levels by 0.3% to 1.3% and 1.7% to 4.9%, respectively. The efficacy of DPP-4 inhibitor treatment is high among HD patients, and no patients exhibited significant severe adverse effects such as hypoglycemia and liver dysfunction. DPP-4 inhibitors are key drugs in new treatment strategies for HD patients with diabetes and with limited choices for diabetes treatment.
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12
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Abstract
In patients with diabetes receiving chronic haemodialysis, both very high and low glucose levels are associated with poor outcomes, including mortality. Conditions that are associated with an increased risk of hypoglycaemia in these patients include decreased gluconeogenesis in the remnant kidneys, deranged metabolic pathways, inadequate nutrition, decreased insulin clearance, glucose loss to the dialysate and diffusion of glucose into erythrocytes during haemodialysis. Haemodialysis-induced hypoglycaemia is common during treatments with glucose-free dialysate, which engenders a catabolic status similar to fasting; this state can also occur with 5.55 mmol/l glucose-containing dialysate. Haemodialysis-induced hypoglycaemia occurs more frequently in patients with diabetes than in those without. Insulin therapy and oral hypoglycaemic agents should, therefore, be used with caution in patients on dialysis. Several hours after completion of haemodialysis treatment a paradoxical rebound hyperglycaemia may occur via a similar mechanism as the Somogyi effect, together with insulin resistance. Appropriate glycaemic control tailored for patients on haemodialysis is needed to avoid haemodialysis-induced hypoglycaemia and other glycaemic disarrays. In this Review we summarize the pathophysiology and current management of glycaemic disarrays in patients on haemodialysis.
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Affiliation(s)
- Masanori Abe
- Divisions of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, 30-1, Oyaguchi Kami-chou, Itabashi-ku, Tokyo 173-8610, Japan
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, Department of Medicine, University of California, Irvine, 101 The City Drive South, Orange, CA 92868, USA
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Nakao T, Inaba M, Abe M, Kaizu K, Shima K, Babazono T, Tomo T, Hirakata H, Akizawa T. Best Practice for Diabetic Patients on Hemodialysis 2012. Ther Apher Dial 2015; 19 Suppl 1:40-66. [DOI: 10.1111/1744-9987.12299] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Masanori Abe
- Japanese Society for Dialysis Therapy; Tokyo Japan
| | - Kazo Kaizu
- Japanese Society for Dialysis Therapy; Tokyo Japan
| | - Kenji Shima
- Japanese Society for Dialysis Therapy; Tokyo Japan
| | | | - Tadashi Tomo
- Japanese Society for Dialysis Therapy; Tokyo Japan
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14
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Fukami K, Shibata R, Nakayama H, Yamada K, Okuda S, Koga M. Serum albumin-adjusted glycated albumin is a better indicator of glycaemic control in diabetic patients with end-stage renal disease not on haemodialysis. Ann Clin Biochem 2015; 52:488-96. [DOI: 10.1177/0004563214568162] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2014] [Indexed: 11/17/2022]
Abstract
Backgrounds Diabetic patients with end-stage renal disease who are not on haemodialysis show low concentrations of HbA1c and glycated albumin due to renal anaemia and proteinuria, respectively. In the present study, we examined whether serum albumin-adjusted glycated albumin could accurately reflect glycaemic control in these patients. Methods To examine the correlation between glycated albumin and serum albumin (Study 1), 49 diabetic patients with end-stage renal disease not on haemodialysis were used. To evaluate the association between the glycaemic control indicators and the glycaemic control state (Study 2), 30 diabetic patients with end-stage renal disease were enrolled. The estimated HbA1c and the estimated glycated albumin concentrations were calculated based on the mean blood glucose concentrations obtained from the diurnal variation. The adjusted glycated albumin concentrations were calculated from the regression formula between the serum albumin and glycated albumin obtained from Study 1. Results No significant correlation was found between the measured HbA1c and estimated HbA1c concentrations. The estimated HbA1c (inversely) and measured HbA1c/estimated HbA1c ratio (positively), but not measured HbA1c, showed a significant correlation with Hb concentrations. The estimated glycated albumin was positively associated with the measured glycated albumin and adjusted glycated albumin concentrations. Although measured glycated albumin/estimated glycated albumin ratio was positively correlated with serum albumin, there was no significant association between the adjusted glycated albumin/estimated glycated albumin ratio and serum albumin, Hb and estimated glomerular filtration rate. Conclusions We found for the first time that the adjustment of glycated albumin by serum albumin could be useful to determine glycaemic control in diabetic patients with end-stage renal disease not on haemodialysis. These findings suggest that adjusted glycated albumin might be a better indicator of glycaemic control than measured HbA1c and measured glycated albumin in these patients.
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Affiliation(s)
- Kei Fukami
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Ryo Shibata
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Hitomi Nakayama
- Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kentaro Yamada
- Division of Endocrinology and Metabolism, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Seiya Okuda
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Masafumi Koga
- Department of Internal Medicine, Kawanishi City Hospital, Kawanishi, Japan
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Li H, Feng SJ, Zhang GZ, Wang SX. Correlation of lower concentrations of hydrogen sulfide with atherosclerosis in chronic hemodialysis patients with diabetic nephropathy. Blood Purif 2014; 38:188-94. [PMID: 25531647 DOI: 10.1159/000368883] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/03/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To explore the relationship between hydrogen sulfide (H2S) and uremic accelerated atherosclerosis (UAAS) in chronic hemodialysis patients with diabetic nephropathy (CHD/DN). METHODS A total of 36 CHD/DN and 32 chronic hemodialyzed non-diabetic patients with chronic glomerulonephritis (CHD/non-DN) were studied. Plasma H2S was measured with a sulfide sensitive electrode. RESULTS Plasma H2S in CHD/DN was significantly lower than that in CHD/non-DN patients. Plasma H2S was positively correlated with plasma TGF-β1, and negatively correlated with MMP-12 in CHD/DN patients. CHD/DN patients exhibited higher CCA-IMT, hsCRP, and lower H2S levels than in CHD/non-DN patients. Moreover, in CHD/DN patients, CCA-IMT was negatively correlated with plasma H2S, and positively correlated with hsCRP and LDL. On multiple regression analysis, H2S levels exhibited independent association with IMT in CHD/DN patients. CONCLUSIONS These findings suggest possible linkage between H2S metabolism and TGF-β/Smad signaling pathway modulation abnormalities that may contribute to the development of UAAS in CHD/DN patients.
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Affiliation(s)
- Han Li
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Nephrology Faculty, Capital Medical University, Beijing, China
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16
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Abstract
The main purpose of treating diabetes is to prevent the onset and the progression of diabetic chronic complications. Since the mechanism of onset of chronic complications is still not well understood, the main strategy to achieve this purpose is to bring the plasma glucose level in diabetic patients as close as possible to that in healthy subjects and try to maintain good glycemic control over the long term. Glycated hemoglobin (HbA1c), glycated albumin (GA), fructosamine, and 1,5-anhydroglucitol (1,5 AG) are used for evaluating glycemic control. At present, HbA1c is widely used as a gold standard index for glycemic control in clinical practice. While HbA1c reflects the long-term glycemic control state (for the past 1-2 months), it does not accurately reflect glycemic control in the clinical state in which glycemic control improves or deteriorates in the short-term. It is also known that HbA1c in patients with hematological disorders such as anemia and variant hemoglobin shows an abnormal value. In addition, HbA1c mainly reflects the mean plasma glucose but does not reflect the postprandial plasma glucose. On the other hand, GA and 1,5-AG reflect intermediate- or short-term glycemic control and are not influenced by hemoglobin metabolism. While 1,5-AG is known to reflect the postprandial plasma glucose, it was shown recently that GA also reflects the postprandial plasma glucose. This chapter summarizes the measurement methods, usage methods, evidence, and problems concerning such indices for glycemic control.
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Nakamura Y, Tsuji M, Hasegawa H, Kimura K, Fujita K, Inoue M, Shimizu T, Gotoh H, Goto Y, Inagaki M, Oguchi K. Anti-inflammatory effects of linagliptin in hemodialysis patients with diabetes. Hemodial Int 2014; 18:433-42. [PMID: 24405885 DOI: 10.1111/hdi.12127] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Inflammation and glycemic control are important prognosis-related factors for hemodialysis (HD) patients; moreover, inflammation affects insulin secretion. Here, we evaluated the anti-inflammatory effects of monotherapy with linagliptin-a dipeptidase-4 inhibitor-in HD patients with type 2 diabetes. We examined 21 diabetic HD patients who were not receiving oral diabetes drugs or insulin therapy and with poor glycemic control (glycated albumin [GA] level, >20%). Linagliptin (5 mg) was administered to the patients daily. The levels of prostaglandin E2 (PGE2), interleukin-6 (IL-6), high-sensitivity C-reactive protein, GA, blood glucose, and active glucagon-like peptide-1 were determined before and 6 months after treatment. Body weight and serum levels of albumin, hemoglobin, total cholesterol, and low-density lipoprotein cholesterol were also recorded before and after treatment. The levels of PGE2 and GA were significantly decreased 1 month after starting linagliptin therapy, whereas the IL-6 levels were significantly decreased 6 months after starting linagliptin therapy. After 6 months of treatment, the PGE2 levels decreased from 188 ± 50 ng/mL to 26 ± 5 ng/mL; IL-6 levels, from 1.5 ± 0.4 pg/mL to 0.6 ± 0.1 pg/mL; and GA levels, from 21.3% ± 0.6% to 18.0% ± 0.6%. Glucagon-like peptide-1 levels increased 2.5-fold during the treatment. Over the 6-month treatment period, body weight and levels of high-sensitivity C-reactive protein, blood glucose, albumin, hemoglobin, and cholesterol did not change; none of the patients exhibited hypoglycemia. The anti-inflammatory effects of linagliptin monotherapy indicate that it may serve as a useful glucose control strategy for HD patients with diabetes.
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Affiliation(s)
- Yuya Nakamura
- Saiyu Soka Hospital, Soka, Japan; Department of Pharmacology, School of Medicine, Showa University, Tokyo, Japan
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Isshiki K, Nishio T, Isono M, Makiishi T, Shikano T, Tomita K, Nishio T, Kanasaki M, Maegawa H, Uzu T. Glycated albumin predicts the risk of mortality in type 2 diabetic patients on hemodialysis: evaluation of a target level for improving survival. Ther Apher Dial 2013; 18:434-42. [PMID: 24251784 DOI: 10.1111/1744-9987.12123] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Glycated albumin (GA) is considered a more reliable marker than glycated hemoglobin (HbA1c) for monitoring glycemic control, particularly in diabetic hemodialysis patients. We investigated the associations of GA, HbA1c, and random serum glucose levels with survival, and evaluated possible targets for improving survival in diabetic hemodialysis patients. In this prospective, longitudinal, observational study, we enrolled 90 diabetic hemodialysis patients across six dialysis centers in Japan. The median duration of follow-up was 36.0 months (mean follow-up, 29.8 months; range, 3-36 months). There were 11 deaths during the observation period. GA was a significant predictor for mortality (hazard ratio, 1.143 per 1% increase in GA; 95% confidence interval, 1.011-1.292; P = 0.033), whereas HbA1c and random glucose levels were not predictors for mortality. Receiver operating characteristics curve analysis showed that the cutoff value of GA for predicting the risk of mortality was 25%. In the Kaplan-Meier analysis, the cumulative survival rate was significantly greater in patients with GA ≤ 25% than in patients with GA >25%. GA predicted the risk of all-cause and cardiovascular mortality in diabetic hemodialysis patients. Our results suggest that GA ≤ 25% is an appropriate target for improving survival in diabetic hemodialysis patients.
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Affiliation(s)
- Keiji Isshiki
- Department of Medicine, Shiga University of Medical Science, Otsu, Japan
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Safety and efficacy of teneligliptin: a novel DPP-4 inhibitor for hemodialysis patients with type 2 diabetes. Int Urol Nephrol 2013; 46:427-32. [PMID: 24014134 DOI: 10.1007/s11255-013-0552-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 08/22/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE Teneligliptin is a novel DPP-4 inhibitor in development for treating type 2 diabetes mellitus that does not require dose adjustment for diabetic patients with end-stage renal disease; however, it had not been known whether or not teneligliptin is safe or potent in dialysis patients. We conducted a prospective study to assess the utility of teneligliptin for diabetic patients undergoing hemodialysis. METHODS Blood glucose, glycated albumin, and HbA1c were measured every 4 weeks, at 4, 12, 20, and 28 weeks, and every 8 weeks, respectively, for patients treated with teneligliptin (n = 14; 7 patients newly started and 7 that switched from other medications) and patients of a control group who continued ongoing antidiabetic therapy (n = 29). RESULTS Blood glucose level showed a 36.7 mg/dl decrease from 4 weeks in the teneligliptin group (p < 0.05). The differences in glycated albumin (at 28 w) and HbA1c (at 24 w) between the teneligliptin group and the control group were -3.1 % (p < 0.05) and -0.57 % (p = 0.057), respectively. These parameters also decreased in patients who switched from voglibose 0.2 mg t.i.d. or vildagliptin 50 mg qd after teneligliptin administration. No case with hypoglycemia was identified. One patient had the dose of a laxative administered for constipation increased; however, no patient ceased teneligliptin due to side effects. CONCLUSION Teneligliptin 20 mg is well tolerated, safe, and significantly improves glycemic control in diabetic patients with end-stage renal disease. Teneligliptin 20 mg once daily was considered to be more potent than voglibose 0.2 mg t.i.d. or vildagliptin 50 mg qd.
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