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Exp Clin Endocrinol Diabetes 2017; 125(06): 384-391
DOI: 10.1055/s-0042-124577
Article
© Georg Thieme Verlag KG Stuttgart · New York

Influence of Erythropoiesis-Stimulating Agents on HbA1c and Fructosamine in Patients with Haemodialysis

Franz Maximilian Rasche
1   Department of Internal Medicine, Neurology, and Dermatology, Clinic for Endocrinology and Nephrology, Section of Nephrology, Leipzig University, Leipzig, Germany
,
Thomas Ebert
1   Department of Internal Medicine, Neurology, and Dermatology, Clinic for Endocrinology and Nephrology, Section of Nephrology, Leipzig University, Leipzig, Germany
,
Julia Beckmann
1   Department of Internal Medicine, Neurology, and Dermatology, Clinic for Endocrinology and Nephrology, Section of Nephrology, Leipzig University, Leipzig, Germany
,
Volker Busch
2   Center for Geriatric Medicine at Bezirksklinikum Regensburg, Department of Psychiatry and Psychotherapy, Regensburg University, Regensburg, Germany
,
Filip Barinka
2   Center for Geriatric Medicine at Bezirksklinikum Regensburg, Department of Psychiatry and Psychotherapy, Regensburg University, Regensburg, Germany
,
Wilma Gertrud Rasche
3   Department of Head Medicine and Oral Health, Department of Ophthalmology, University Leipzig, Leipzig, Germany
,
Tom H. Lindner
1   Department of Internal Medicine, Neurology, and Dermatology, Clinic for Endocrinology and Nephrology, Section of Nephrology, Leipzig University, Leipzig, Germany
,
Jochen G. Schneider   *
4   Translational & Experimental Medicine, Luxembourg Centre de Systems Biomedicine, Luxembourg
5   Department of Internal Medicine II, Saarland University, Homburg Saar, Germany
,
Stephan Schiekofer   *
2   Center for Geriatric Medicine at Bezirksklinikum Regensburg, Department of Psychiatry and Psychotherapy, Regensburg University, Regensburg, Germany
› Author Affiliations
Further Information

Publication History

received 15 November 2016
first decision 19 December 2016

accepted 23 December 2016

Publication Date:
13 April 2017 (online)

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Abstract

Introduction

HbA1c is the most accepted laboratory parameter for the long term observation of glucose control. There is still much of a debate about the use of HbA1c as a metabolic indicator in diabetic patients (DM) on haemodialysis (HD) and erythropoiesis-stimulating agent (ESA) therapy because of the altered erythrocyte turn over in patients with chronic kidney disease and haemodialysis (CKD5D).

Patients and Methods

In 102 CKD5 patients with and without diabetes mellitus, we examined the dose dependent variability in HbA1c and fructosamine levels under haemodialysis and treated with epoetin α (n=48) and a new generation agent with continuous stimulation of methoxy polyethylene glycol epoetin beta (C.E.R.A.; n=54).

Results

HbA1c levels were affected by therapy with ESA treatments. ESA dose was inversely correlated with HbA1c and an escalation of 10.000 IU per week induced an estimated decrease of HbA1c of 0.6 percent. In addition, the increase of reticulocyte number as a marker for erythropoiesis was significantly inversely correlated with the increase of ΔHbA1c. ESA treatments had no such effect on the alternative metabolic parameter fructosamine. When compared, both therapeutic agents had comparable success in attaining haemoglobin (Hb) target values. C.E.R.A. showed better correlation and was more effective over a longer dose interval.

Conclusions

Our results show that HbA1c levels in patients should be carefully interpreted based on interfering factors. Nevertheless, HbA1c is currently the most consistent parameter for use ascertaining metabolic status of patients suffering from diabetes mellitus.

Key words

HbA1c - fructosamine - haemodialysis - erythropoiesis-stimulating agents - C.E.R.A. - epoietin α

* Both authors contributed equally


 

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