Keywords
Nephropathy
Glycosylated serum albumin
Glycosylated hemoglobin
Glycosylation
How to Cite
Abstract
Background: Biomarkers are widely used to monitor complications of various chronic degenerative diseases such as Diabetes Mellitus (DM), being a field of profound dynamism in which there have been important methodological advances and use of new analytical techniques for their determination and interpretation. Renal complications related to DM represent a challenge in medical practice, due to the high mortality rate they generate. Glycosylated hemoglobin (HbA1c) has long been a biomarker of great importance; currently, glycosylated albumin (GA) is also used; however, there is divergence in its use.
Purpose: A systematic review was carried out to evaluate the benefits of both paraclinical biomarkers, establishing inclusion criteria for this purpose.
Methodology: The MeSH descriptors were established, and once the literature search was performed, the flow chart proposed by PRISMA was used to synthesize the main findings.
Results: N=15 manuscripts were selected showing that GA is an emerging parameter that can determine with greater sensitivity and specificity the progression to more advanced stages of renal disease and mortality in diabetic patients; although, it has disadvantages with respect to HbA1c, such as the absence of a reference range and the lack of its continuous use in routine laboratories due to the inherent methodology.
Conclusions: HbA1c continues to be the most widely used biomarker; however, the use of GA should be promoted as a new useful tool in the management of nephropathic diabetic patients.
References
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
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