The clinical usefulness of glycated albumin in patients with diabetes and chronic kidney disease: Progress and challenges

J Diabetes Complications. 2018 Sep;32(9):876-884. doi: 10.1016/j.jdiacomp.2018.07.004. Epub 2018 Jul 11.

Abstract

Prolonged hyperglycemia leads to a non-enzymatic glycation of proteins, and produces Amadori products, such as glycated albumin (GA) and glycated hemoglobin (HbA1c). The utility of HbA1c in the setting of chronic kidney disease (CKD) may be problematic since altered lifespan of red blood cells, use of iron and/or erythropoietin therapy, uremia and so on. Therefore, as an alternative marker, GA has been suggested as a more reliable and sensitive glycemic index in patients with CKD. In addition to the mean plasma glucose concentration, GA also reflects postprandial plasma glucose and glycemic excursion. Besides, with a half-life of approximately 2-3 weeks, GA may reflect the status of blood glucose more rapidly than HbA1c. GA is also an early precursor of advanced glycation end products (AGEs), which cause alterations in various cellular proteins and organelles. Thus, high GA levels may correlate with adverse outcomes of patients with CKD. In this review, the clinical usefulness of GA was discussed, including a comparison of GA with HbA1c, the utility and limitations of GA as a glycemic index, its potential role in pathogenesis of diabetic nephropathy and the correlations between GA levels and outcomes, specifically in patients with diabetes and CKD.

Keywords: Chronic kidney disease; Diabetes mellitus; Glycated albumin; Glycated hemoglobin; Glycemic control.

Publication types

  • Review

MeSH terms

  • Biomarkers / analysis
  • Biomarkers / blood
  • Blood Glucose / metabolism
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / diagnosis*
  • Diabetic Nephropathies / blood
  • Diabetic Nephropathies / diagnosis*
  • Diagnostic Techniques, Endocrine* / standards
  • Diagnostic Techniques, Endocrine* / trends
  • Glycated Hemoglobin / analysis
  • Glycated Hemoglobin / metabolism
  • Glycated Serum Albumin
  • Glycation End Products, Advanced / blood
  • Humans
  • Predictive Value of Tests
  • Prognosis
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / diagnosis*
  • Serum Albumin / analysis*
  • Serum Albumin / metabolism

Substances

  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A
  • Glycation End Products, Advanced
  • Serum Albumin
  • Glycated Serum Albumin