Cycling of hemoglobin A1c associated with hemoglobin cycling in diabetic patients under hemodialysis and its theoretical simulation

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• 作者：Yasuhiro Tahara ; Hidenori Kido ; Akira Nagamatsu ; Yukio Tamura…
• 关键词：Renal anemia ; Erythropoiesis ; stimulating agent ; Hemoglobin cycling ; Hemoglobin A1c ; Glycated albumin
• 刊名：Diabetology International
• 出版年：2015
• 出版时间：September 2015
• 年：2015
• 卷：6
• 期：3
• 页码：219-225
• 全文大小：813 KB
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• 作者单位：Yasuhiro Tahara (1)
  Hidenori Kido (2)
  Akira Nagamatsu (3)
  Yukio Tamura (4)
  Kumiko Nishiyama (5)
  
  1. Diabetes Division, Department of Internal Medicine, Meimai Central Hospital, Matsugaoka 4-1-32, Akashi, Hyogo, 673-0862, Japan
  2. Nephrology Division, Department of Internal Medicine, Meimai Central Hospital, Akashi, Japan
  3. Department of Medical Engineering, Meimai Central Hospital, Akashi, Japan
  4. Department of Internal Medicine, Meimai Central Hospital, Akashi, Japan
  5. Department of Pharmacy, Miki City Hospital, Miki, Japan
  
• 刊物主题：Diabetes; Metabolic Diseases; Endocrinology;
• 出版者：Springer Japan
• ISSN：2190-1686

文摘

Levels of hemoglobin A1c (HbA1c) in patients under hemodialysis (HD) show lower values than expected based on plasma glucose levels, and they fluctuate according to changes in the weekly dosage of erythropoiesis-stimulating agent (ESA) administered for the treatment of renal anemia. We should therefore consider how these factors affect the levels of HbA1c when HbA1c is used as a marker of glycemic control in HD diabetic patients. To clarify the relationship between the weekly ESA dosage and HbA1c levels, we examined whether HbA1c levels show cyclic changes associated with hemoglobin (Hb) cycling in HD diabetic patients. In 3 of the 39 HD diabetic patients studied, the weekly ESA dosage was frequently changed and Hb levels showed Hb cycling. The HbA1c levels in these three patients also showed cyclic changes that synchronized Hb cycling. To quantitatively analyze the relationship between ESA and HbA1c, we established a mathematical model of Hb glycation in HD diabetic patients. The simulation results using this model agreed well with the observed data. The present model is considered to provide a new method for the analysis of HbA1c levels in HD diabetic patients. Keywords Renal anemia Erythropoiesis-stimulating agent Hemoglobin cycling Hemoglobin A1c Glycated albumin