Glycated Albumin and Cardiovascular Mortality in CKD Stage V Patients with Diabetes Mellitus: A Five-Year Follow-Up Study

作者：Bulatovic A, Dimkovic N, Jelic S, Jankovic A, Damjanovic T, Todorov-Sakic V, Bjedov J, Stopic B, Djuric P, Naumovic R · 发表于：International journal of molecular sciences · 年份：2026 · DOI：10.3390/ijms27052215 · 被引用次数：19 · 研究领域：Cardiovascular Diseases、Serum Albumin、Renal Insufficiency, Chronic、Diabetes Mellitus、Humans、Glycated Serum Albumin、Glycation End Products, Advanced、Follow-Up Studies、Female、Male、Glycated Hemoglobin、Biomarkers

Glycemic assessment in patients with chronic kidney disease (CKD) Stage V on hemodialysis (HD) is limited by the inaccuracy of hemoglobin A1c (HbA1c), mainly due to anemia, shortened erythrocyte lifespan, and erythropoiesis-stimulating agent (ESA) therapy. Glycated albumin (GA), independent of erythrocyte turnover, may better reflect glycemic exposure. We evaluated the diagnostic performance and clinical utility of GA as a biomarker of poor glycemic control and cardiovascular risk in patients with diabetes mellitus (DM). A cross-sectional analysis and five-year prospective follow-up were conducted in three subgroups: HD+DM+ (n = 40), HD- DM+ (n = 15), and HD+DM- (n = 22). Glycemic markers (mean plasma glucose over 3 months (PG3m), GA, and HbA1c) were compared between groups. GA levels were significantly higher in HD+DM+ patients (p < 0.001) and showed the strongest correlation with PG3m. GA independently predicted poor glycemic control (OR 3.23; 95% CI 1.54-6.77; p = 0.002) and demonstrated high diagnostic accuracy (AUC 0.873; optimal cut-off 10%). During the five-year follow-up, CV mortality was 35%, and 85% of deceased patients had GA > 10%. Although Cox regression did not reach statistical significance, GA showed a consistent trend toward higher CV mortality risk after adjustment for age and HD duration (HR 2.56; 95% CI 0.57-11.44; p = 0.21), whereas HbA1c was not prognostic (HR 1.39; 95% CI 0.49-3.91; p = 0.28). GA appears to be a clinically useful marker of glycemic cont...