Serum albumin-adjusted glycated albumin is a better predictor of mortality in diabetic patients with end-stage renal disease on hemodialysis

Aims Glycated albumin (GA) is a marker for monitoring glycemic control in diabetic patients with end-stage renal disease (ESRD). We evaluated whether serum albumin-adjusted GA (adjusted GA) could predict mortality in diabetic patients with ESRD on hemodialysis. Methods Seventy-eight patients with type 2 diabetes treated with regular hemodialysis were enrolled and followed up for 5-years. The adjusted GA was calculated from the regression formula and mean GA. The cut-off values for GA and adjusted GA that predicted mortality risk were determined using receiver operating characteristic curve analysis. Results During the follow-up period (median: 36 months), 15 patients died. In the Kaplan-Meier analysis, there were no significant differences in the 5-year cumulative survival rate (58.3% [GA ≥ 19.8%] vs. 88.6% [GA < 19.8%], P = 0.075). Conversely, this rate was significantly higher in patients with adjusted GA < 21.2% than adjusted GA ≥ 21.2% (86.4 vs. 49.5%, P = 0.0068). After adjustment for other confounders, adjusted GA ≥ 21.2% was an independent predictor for mortality (hazard ratio 3.76, 95% confidence interval 1.12-17.44, P = 0.031), but GA ≥ 19.8% was not (hazard ratio 2.63, 95% confidence interval 0.65-17.69, P = 0.19). Conclusions Adjusted GA is a better predictor of mortality than GA in diabetic patients with ESRD on hemodialysis.