Brechas metodológicas en la determinación de hemoglobina y albúmina glicosilada en el diagnóstico y seguimiento de la nefropatía diabética
PDF

Palabras clave

diabetes mellitus
nefropatía
albúmina sérica glicosilada
hemoglobina glicosilada
glicosilación

Cómo citar

1.
Rivadeneira Arévalo M, Ponce R, Robles Urgilez M, Bracho Mora A. Brechas metodológicas en la determinación de hemoglobina y albúmina glicosilada en el diagnóstico y seguimiento de la nefropatía diabética. Rev. Colomb. Nefrol. [Internet]. 12 de febrero de 2025 [citado 29 de abril de 2025];12(1). Disponible en: https://revistanefrologia.org/index.php/rcn/article/view/817

Resumen

Contexto: los biomarcadores son ampliamente empleados para monitorear complicaciones de diversas enfermedades crónico-degenerativas como la diabetes mellitus (DM) y también son parte de un campo de profundo dinamismo, en el cual ha habido importantes avances metodológicos y se han empleado nuevas técnicas analíticas para su determinación e interpretación. Las complicaciones renales relacionadas con DM representan un desafío en la práctica médica, debido a la elevada tasa de mortalidad que generan. Por su parte, la hemoglobina glicosilada (HbA1c) ha sido, por larga data, un biomarcador de gran importancia. En la actualidad, también se emplea la albúmina glicosilada (AG), sin embargo, existe divergencia en su uso.

Objetivo: se realizó una revisión sistemática, con el objetivo de evaluar los beneficios de ambos biomarcadores paraclínicos, instaurando criterios de inclusión para tal fin.

Metodología: se establecieron los descriptores MeSH y, una vez realizada la búsqueda bibliográfica, se procedió a realizar el flujograma propuesto por la declaración Prisma y a sintetizar los principales hallazgos.

Resultados: se seleccionaron 15 manuscritos que mostraron que la AG es un parámetro emergente que puede determinar, con una mayor sensibilidad y especificidad, la progresión hacia los estadios más avanzados de la enfermedad renal y la mortalidad en pacientes diabéticos, aunque posee desventajas con respecto a la HbA1c, como la ausencia de un rango de referencia y la falta de su uso continuo en los laboratorios de rutina, debido a la metodología inherente.

Conclusiones: la HbA1c continúa siendo el biomarcador de mayor uso, sin embargo, debe promoverse el uso de la AG como una nueva herramienta de utilidad en el manejo de los pacientes diabéticos nefrópatas.

https://doi.org/10.22265/acnef.12.1.817
PDF

Citas

Pletcher MJ, Pignone M. Evaluating the clinical utility of a biomarker: a review of methods for estimating health impact. Circulation. 2011;123(10):1116-24. https://doi.org/10.1161/circulationaha.110.943860

Bernhardt AM, Tiedt S, Teupser D, Dichgans M, Meyer B, Gempt J, et al. A unified classification approach rating clinical utility of protein biomarkers across neurologic diseases. EBioMedicine. 2023;89:104456. https://doi.org/10.1016/j.ebiom.2023.104456

Dorcely B, Katz K, Jagannathan R, Chiang SS, Oluwadare B, Goldberg IJ, et al. Novel biomarkers for prediabetes, diabetes, and associated complications. Diabetes, Metab Syndr Obes. 2017;10:345-61. https://doi.org/10.2147/dmso.S100074

Long J, Yang Z, Wang L, Han Y, Peng C, Yan C, et al. Metabolite biomarkers of type 2 diabetes mellitus and pre-diabetes: a systematic review and meta-analysis. BMC Endocr Disord. 2020;20:174. https://doi.org/10.1186/s12902-020-00653-x

Min TZ, Stephens MW, Kumar P, Chudleigh RA. Renal complications of diabetes. Br Med Bull. 2012;104(1):113-27. https://doi.org/10.1093/bmb/lds030

Bonner R, Albajrami O, Hudspeth J, Upadhyay A. Diabetic kidney disease. Prim Care. 2020;47(4):645-59. https://doi.org/10.1016/j.pop.2020.08.004

ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. Classification and diagnosis of diabetes: standards of care in diabetes-2023. Diabetes Care. 2023;46(supl. 1):S19-40. https://doi.org/10.2337/dc23-S002

Hung CC, Zhen YY, Niu SW, Lin KD, Lin HY, Lee JJ, et al. Predictive value of HbA1c and metabolic syndrome for renal outcome in non-diabetic CKD stage 1-4 patients. Biomedicines. 2022;10(8):1858 https://doi.org/10.3390/biomedicines10081858

Kuo IC, Lin HY, Niu SW, Hwang DY, Lee JJ, Tsai JC, et al. Glycated hemoglobin and outcomes in patients with advanced diabetic chronic kidney disease. Sci Rep. 2016;6:20028 https://doi.org/10.1038/srep20028

Habte-Asres HH, Murrells T, Nitsch D, Wheeler DC, Forbes A. Glycaemic variability and progression of chronic kidney disease in people with diabetes and comorbid kidney disease: retrospective cohort study, Diabetes Res Clin Pract. 2022;193:110117. https://doi.org/10.1016/j.diabres.2022.110117

Habte-Asres HL, Wheeler D, Forbes R. The association between glycaemic variability and progression of chronic kidney disease: a systematic review. SN Compr Clin Med. 2022;4:102. https://doi.org/10.1007/s42399-022-01182-5

Pohanka M. Glycated hemoglobin and methods for its point of care testing, Biosensors. 2021;11(3):70. https://doi.org/10.3390/bios11030070

Little R, Roberts WL. A review of variant hemoglobins interfering with hemoglobin A1c measurement. J Diabetes Sci Technol. 2009;3(3):446-51. https://doi.org/10.1177/193229680900300307

Rhea JM, Molinaro R. Pathology consultation on HbA1c methods and interferences, Am J Clin Pathol. 2014;141(1):5-16. https://doi.org/10.1309/ajcpq23gttmlaevl

Zhan Z, Li Y, Zhao Y, Zhang H, Wang Z, Fu B, et al. A review of electrochemical sensors for the detection of glycated hemoglobin. Biosensors. 2022;12(4):221. https://doi.org/10.3390/bios12040221

Rahbar S. The discovery of glycated hemoglobin: a major event in the study of nonenzymatic chemistry in biological systems. Ann N Y Acad Sci. 2005;1043:9-19. https://doi.org/10.1196/annals.1333.002

Schnell O, Crocker JB, Weng J. Impact of HbA1c testing at point of care on diabetes management. J Diabetes Sci Technol. 2017;11(3):611-7. https://doi.org/10.1177/1932296816678263

Ortiz-Martínez M, González-González M, Martagón AJ, Hlavinka V, Willson RC, Rito-Palomares M. Recent developments in biomarkers for diagnosis and screening of type 2 diabetes mellitus. Curr Diab Rep. 2022;22(3):95-115. https://doi.org/10.1007/s11892-022-01453-4

Ferrario L, Schettini F, Avogaro A, Bellia C, Bertuzzi F, Bonetti G, et al. Glycated albumin for glycemic control in T2DM population: a multi-dimensional evaluation. Clinicoecon Outcomes Res. 2021;13:453-64. https://doi.org/10.2147/ceor.S304868

Correa Freitas PA, Rozales Ehlert L, Lins Camargo J. Glycated albumin: a potential biomarker in diabetes. Arch Endocrinol Metab. 2017;61(3):296-304. https://doi.org/10.1590/2359-3997000000272

Furusyo N, Koga T, Ai M, Otokozawa S, Kohzuma T, Ikezaki H, et al. Utility of glycated albumin for the diagnosis of diabetes mellitus in a Japanese population study: results from the Kyushu and Okinawa Population Study (KOPS). Diabetologia. 2011;54(12):3028-36. https://doi.org/10.1007/s00125-011-2310-6

Hwang YC, Jung CH, Ahn HY, Jeon WS, Jin SM, Woo JT, et al. Optimal glycated albumin cutoff value to diagnose diabetes in Korean adults: a retrospective study based on the oral glucose tolerance test. Clinica Chim Acta. 2014;437:1-5. https://doi.org/10.1016/j.cca.2014.06.027

Ikezaki H, Furusyo N, Ihara T, Hayashi T, Ura K, Hiramine S, et al. Glycated albumin as a diagnostic tool for diabetes in a general Japanese population. Metabolism. 2015;64(6):698-705. https://doi.org/10.1016/j.metabol.2015.03.003

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71

He R, Xuan Y, Zhu L, Pang S, Qin L, Tian J, et al. Low blood glucose index associated with cardiovascular events in diabetic hemodialysis patients. Blood Purif. 2023;52(9):824-34. https://doi.org/10.1159/000531964

Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero JJ, Chan W, et al. KDOQI clinical practice guideline for nutrition in CKD: 2020 update. Am J Kidney Dis. 2020;76(supl. 1):S1-107. https://doi.org/10.1053/j.ajkd.2020.05.006

Kim H, Tang O, Rebholz CM, Grams ME, Coresh J, Christenson RH, et al. Associations of glycated albumin and HbA1c with chronic kidney disease in US adults. J Appl Lab Med. 2022;7(4):842-53. https://doi.org/10.1093/jalm/jfac006

Little RR, Rohlfing CL, Tennill AL, Hanson SE, Connolly S, Higgins T, et al. Measurement of Hba1C in patients with chronic renal failure. Clin Chim Acta. 2013;418:73-6. https://doi.org/10.1016/j.cca.2012.12.022

Rooney MR, Daya N, Tang O, McEvoy JW, Coresh J, Christenson RH, et al. Glycated albumin and risk of mortality in the US adult population, clinical chemistry. 2022;68(3):422-30. https://doi.org/10.1093/clinchem/hvab232

Kim IY, Kim MJ, Lee DW, Lee SB, Rhee H, Song SH, et al. Glycated albumin is a more accurate glycaemic indicator than haemoglobin A(1c) in diabetic patients with pre-dialysis chronic kidney disease. Nephrology. 2015;20(10):715-20. https://doi.org/10.1111/nep.12508

Inaba M, Okuno S, Kumeda Y, Yamada S, Imanishi Y, Tabata T, et al. Glycated albumin is a better glycemic indicator than glycated hemoglobin values in hemodialysis patients with diabetes: effect of anemia and erythropoietin injection. J Am Soc Nephrol. 2007;18(3):896-903. https://doi.org/10.1681/asn.2006070772

Yamada S, Inaba M, Shidara K, Okada S, Emoto M, Ishimura E, et al. Association of glycated albumin, but not glycated hemoglobin, with peripheral vascular calcification in hemodialysis patients with type 2 diabetes. Life Sci. 2008;83(13-14):516-9. https://doi.org/10.1016/j.lfs.2008.08.001

Sany D, Elshahawy Y, Anwar W. Glycated albumin versus glycated hemoglobin as glycemic indicator in hemodialysis patients with diabetes mellitus: variables that influence. Saudi J Kidney Dis Transpl. 2013;24(2):260-73.

Hoshino J, Hamano T, Abe MI, Hasegawa T, Wada A, Ubara Y, et al. Glycated albumin versus hemoglobin A1c and mortality in diabetic hemodialysis patients: a cohort study, Nephrol Dial Transplant. 2018;33(7):1150-8. https://doi.org/10.1093/ndt/gfy014

Peacock TP, Shihabi ZK, Bleyer AJ, Dolbare EL, Byers JR, Knovich MA, et al. Comparison of glycated albumin and hemoglobin A(1c) levels in diabetic subjects on hemodialysis. Kidney Int. 2008;73(9):1062-8. https://doi.org/10.1038/ki.2008.25

Vos FE, Schollum JB, Coulter CV, Manning PJ, Duffull SB, Walker RJ. Assessment of markers of glycaemic control in diabetic patients with chronic kidney disease using continuous glucose monitoring. Nephrology. 2012;17(2):182-8. https://doi.org/10.1111/j.1440-1797.2011.01517.x

Kobayashi H, Abe M, Yoshida Y, Suzuki H, Maruyama N, Okada K. Glycated albumin versus glycated hemoglobin as a glycemic indicator in diabetic patients on peritoneal dialysis. Int J Mol Sci. 2016;17(5):619. https://doi.org/10.3390/ijms17050619

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(1):3320. https://doi.org/10.1038/s41598-019-39933-5

Freedman BI, Shenoy RN, Planer JA, Clay KD, Shihabi ZK, Burkart JM, et al. Comparison of glycated albumin and hemoglobin A1c concentrations in diabetic subjects on peritoneal and hemodialysis. Perit Dial Int. 2010;30(1):72-9. https://doi.org/10.3747/pdi.2008.00243

Hanai K, Akamatsu M, Fujimori A, Higashi H, Horie Y, Itaya Y, et al. Usefulness of glycated albumin as a predictor of mortality in chronic hemodialysis patients with diabetes: a multi-center, prospective cohort study. Ren Replac Ther. 2020;6:17. https://doi.org/10.1186/s41100-020-00264-1

Hoshino J, Abe M, Hamano T, Hasegawa T, Wada A, Ubara Y, et al. Glycated albumin and hemoglobin A1c levels and cause-specific mortality by patients' conditions among hemodialysis patients with diabetes: a 3-year nationwide cohort study. BMJ Open Diabetes Res Care. 2020;8(1):e001642. https://doi.org/10.1136/bmjdrc-2020-001642

Phillips J, Chen JH, Ooi E, Prunster J, Lim WH. Global epidemiology, health outcomes, and treatment options for patients with type 2 diabetes and kidney failure. Front Clin Diabetes Healthc. 2021;2:731574. https://doi.org/10.3389/fcdhc.2021.731574

Buades JM, Craver L, Del Pino MD, Prieto-Velasco M, Ruiz JC, Salgueira M, et al. Management of kidney failure in patients with diabetes mellitus: what are the best options? J Clin Med. 2021;10(13):2943. https://doi.org/10.3390/jcm10132943

Lee MY, Huang JC, Chen SC, Chiou HYC, Wu PY. Association of HbA1C variability and renal progression in patients with type 2 diabetes with chronic kidney disease stages 3?4. Int J Mol Sci. 2018;19(12):4116. https://doi.org/10.3390/ijms19124116

Koga M, Kasayama S. Clinical impact of glycated albumin as another glycemic control marker. Endocr J. 2010;57(9):751-62. https://doi.org/10.1507/endocrj.k10e-138

Gan T, Liu X, Xu G. Glycated albumin versus HbA1c in the evaluation of glycemic control in patients with diabetes and Chronic Kidney Disease. Kidney Int Rep. 2017;3(3):542-54. https://doi.org/10.1016/j.ekir.2017.11.009

Hoshino J, Abe M, Hamano T, Hasegawa T, Wada A, Nakai S, et al. Glycated albumin to glycated hemoglobin ratio and mortality in diabetic patients on dialysis: a new association. Nephrol Dial Transplant. 2023;38(5):1309-17. https://doi.org/10.1093/ndt/gfac297

Chume FC, Gazzi Schiavenin L, Correa Freitas PA, Pimentel AL, Lins Camargo J. The usefulness of glycated albumin in patients with diabetes and renal disease: a scoping review. J Lab Precis Med. 2022;7:12. https://doi.org/10.21037/jlpm-22-2

Copur S, Siriopol D, Afsar B, Comert MC, Uzunkopru G, Sag AA, et al. Serum glycated albumin predicts all-cause mortality in dialysis patients with diabetes mellitus: meta-analysis and systematic review of a predictive biomarker. Acta Diabetol. 2021;58(1):81-91. https://doi.org/10.1007/s00592-020-01581-x

George C, Matsha TE, Korf M, Zemlin AE, Erasmus RT, Kengne AP. The agreement between fasting glucose and markers of chronic glycaemic exposure in individuals with and without chronic kidney disease: a cross-sectional study. BMC Nephrol. 2020;21(1):32. https://doi.org/10.1186/s12882-020-1697-z

Yazdanpanah S, Rabiee M, Tahriri M, Abdolrahim M, Rajab A, Jazayeri HE, et al. Evaluation of glycated albumin (GA) and GA/HbA1c ratio for diagnosis of diabetes and glycemic control: a comprehensive review. Crit Rev Clin Lab Sci. 2017;54(4):219-32. https://doi.org/10.1080/10408363.2017.1299684

Dozio E, Corradi V, Proglio M, Vianello E, Menicanti L, Rigolini R, et al. 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. https://doi.org/10.1016/j.diabres.2018.03.017

Zheng CM, Ma WY, Wu CC, Lu KC. Glycated albumin in diabetic patients with chronic kidney disease. Clin Chim Acta. 2012;413(19-20):1555-61. https://doi.org/10.1016/j.cca.2012.04.025

Creative Commons License

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.