Evaluation of the role of HbA1c in chronic kidney disease

Introduction: Chronic Kidney Disease (CKD) refers to a group of heterogeneous disorders that results in gradual loss of structure and function of the kidneys. Aim: To evaluate the role of glycated haemoglobin (HBA1c) due to type II diabetes mellitus by correlating glycated haemoglobin with estimated Glomerular Filtration Rate (GFR) and serum creatinine parameters. Materials and Methods: This study was conducted over a period of one year during which 60 patients with CKD were enrolled for the study. Sixty age and sex matched controls were also enrolled. The diagnosis of CKD was done based on estimated Glomerular Filtration Rate (eGFR) calculation after obtaining history/clinico-pathological information. Blood samples were analysed for the following parameters: fasting blood sugar, HBA1c, blood urea, serum creatinine, serum albumin and electrolytes. The eGFR was calculated by using Modification of Diet in Renal Disease equation. Statistical analysis was done by using SPSS software. Results: On comparison, the values of fasting blood sugar, HBA1c, blood urea, serum creatinine and serum potassium levels were significantly higher in CKD cases than in controls (p< 0.001). The values of haemoglobin and serum albumin were found to be significantly lower in the cases than the control group (p< 0.001). Among the CKD cases, correlation studies were done. HBA1c values negatively correlated with eGFR and positively correlated with serum creatinine values. The CKD cases were subdivided based on their stage (stage 3, 4 and 5) and compared with each other. A statistically significant difference (p < 0.001) between median values of HBA1c, eGFR and serum creatinine was observed among the three groups of stage 3, 4 and 5. Conclusion: As the results show, greater glycaemic control is emulated by lower HBA1c levels which in turn are directly related to severity of the renal disease as indicated by the falling eGFR and rising serum creatinine values. These findings suggest that proper and timely control of HbA1c level in patients with chronic renal disease with diabetic aetiology is of utmost importance for staging and prognosis of the disease.