June 25, 2011

HbA1c Ineffective for Patients on Dialysis

I am not sure why it took so long for the medical community to come up with this study. Maybe it is because no one took time to explain glycation to the doctors and what dialysis does to the blood cells and the effects of chronic kidney disease on the body.

This has to be one of the times common sense was not present, and someone saw a chance to spend some money on a study that should not have been needed. Nonetheless, the Wake Forest Baptist Medical Center saw fit to spend the money and determine that indeed the HbA1c test was not reliable for people undergoing dialysis.

The article about this study also uses many catch phrases and terminology to muddy the water and make it seem like the study was of value. Even the opening statement leaves one wondering when the HbA1c became the gold standard for glucose monitoring. There is still a lot of disagreement about this being the appropriate test for diagnosis of diabetes.

Take into account the shorter life span of red blood cells and anemia in dialysis patients, it is no wonder the HbA1c has limited (no, lets state – no value) in dialysis patients. Another test, the glycated albumin or GA assay, appears to be far more effective for dialysis patients. The GA test used in this study is available in Japan, China and South Korea, but is not yet FDA approved in the United States.

I can see the next request for study funding. They will need to know how to translate the HbA1c into meaningful results for patients on dialysis. There will be a new HbA1c table issued for patients on dialysis. This will be related to the GA results so everyone can be on the same page, until the GA test is approved for use in the US.

The researchers instead issued this warning suggesting physicians not rely on the HbA1c in dialysis patients, instead suggesting that blood glucose levels be directly monitored with multiple daily readings until the GA test is available in the states.

Read the article here.

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