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Assessment of Glycated Albumin as a Useful Indicator for Renal Dysfunction in Diabetic and Nondiabetic Population by Nan Duan, Sai-Nan Zhu, Hai-Xia Li, Li-Li Jiao, Hong-Yun Yang, Qi Guo

Background: Glycated albumin (GA) reflects serum glucose of the preceding 2 - 3 weeks and plays an important role in diabetes mellitus (DM). This study aimed at investigating whether GA can assess renal dysfunction in population.
Methods: 3818 individuals attending physical examination were enrolled in this cross-sectional study and divided into five groups: healthy controls, impaired fasting glucose, DM without renal complications, DM with albuminuria, and nondiabetic chronic kidney disease patients. All analyses were conducted using the subjects with both fasting venous blood and morning urine samples.
Results: Among all groups, mean GA, hemoglobin A1c, fasting plasma glucose, and serum creatinine were the highest and estimated glomerular filtration rate (eGFR) was the lowest in DM with albuminuria group. When eGFR was 90 - 105 mL/minute/1.73 m2 or mildly decreased to 60 - 90 mL/minute/1.73 m2, GA increased significantly with elevating albumin-to-creatinine ratio (ACR) from 0 - 10 mg/g to 10 - 30 mg/g to > 30 mg/g (p < 0.001 and p < 0.001). GA increased further when eGFR decreased moderately to severely as a result of renal function continuing to deteriorate (eGFR ≤ 60 mL/minute/1.73 m2).When ACR ≤ 30 mg/g and eGFR ≤ 60 mL/minute/ 1.73 m2, more than 50% subjects were DM patients and had significantly higher GA levels than other subjects with eGFR > 105 mL/minute/1.73 m2. After adjusting demographics, every 5% rise of GA levels showed a 1.778fold increased risk in all subjects (adjusted odds ratio [OR], 1.778; 95% confidence interval [CI], 1.373 - 2.302; p < 0.001) and 1.737-fold risk in DM subjects (adjusted OR, 1.737; 95% CI, 1.221 - 2.471; p = 0.002) for occurrence of ACR > 30mg/g in contrast to ACR ≤ 30 mg/g. Compared to eGFR > 90 mL/minute/1.73 m2, 5% rise of GA levels showed a 1.482-fold risk for eGFR 60 - 90 mL/minute/1.73 m2 (adjusted OR, 1.482; 95% CI, 1.112 - 1.975; p = 0.007) and a 1.996-fold risk for eGFR ≤ 60 mL/minute/1.73 m2 (adjusted OR, 1.996; 95% CI, 1.366 - 2.916; p < 0.001).
Conclusions: Increased GA serves as a risk marker for renal dysfunction. GA combined with eGFR and ACR can reflect renal function changes in population.

DOI: 10.7754/Clin.Lab.2017.161224