• Mehwish Sayed Liaquat National Hospital
  • Farzana Adnan Liaquat National Hospital
  • Muneeba Majeed Liaquat National Hospital


Background: HbA1c is generally conducted to check blood glucose control in diabetic patients. As reported by several recent studies, HbA1c may not be considered as a reliable assay for monitoring glycaemic status in haemodialysis patients. Multiple factors may result in artificially low HbA1c. We sought to confirm this observation by performing a study in which we saw the agreement between expected HbA1c values as indicated by the mean plasma glucose level and the measured HbA1c values of haemodialysis dependent Diabetic patients. Methods: This cross-sectional study was conducted on 45 patients. Daily three readings of capillary blood glucose were taken for three consecutive days in a week, every two weeks in a month for up to three months. Total 54 capillary blood glucose levels were checked in the duration of three months. Mean blood glucose level was calculated at the end of the study and it is used to calculate the ‘expected HbA1c’ levels using a formula. At the offset, HbA1c was measured (at 12 weeks) and was compared with the expected HbA1c. Results: On comparing the expected and measured HbA1c levels in 45 patients on haemodialysis. There is a significant difference between the two levels, with reduced levels of measured HbA1c in majority of patients as compared to expected ones. Conclusion: HbA1c is not a true marker of glucose control in diabetic patients on regular haemodialysis.Keywords: HbA1c; Haemodialysis; glycaemic control; capillary blood glucose; Diabetes Mellitus

Author Biographies

Mehwish Sayed, Liaquat National Hospital

Internal Medicine Postgraduate Trainee

Farzana Adnan, Liaquat National Hospital

Assistant Professor; Nephrology

Muneeba Majeed, Liaquat National Hospital

Department Of Nephrology; Senior Registrar


Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al. The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin dependent diabetes mellitus. N Engl J Med 1993;329(14):977–86.

Oomichi T, Emoto M, Tabata T, Morioka T, Tsujimoto Y, Tahara H, et al. Impact of glycemic control on survival of diabetic patients on chronic regular hemodialysis: a 7-year observational study. Diabetes Care 2006;29(7):1496–1500.

Inaba M, Okuno S, Kumeda Y, Yamada S, Imanishi Y, Tabata T, et al. Glycated albumin is a better glycemic indicator than glycated hemoglobin values in hemodialysis patients with diabetes: effect of anemia and erythropoietin injection. J Am Soc Nephrol 2007;18(3):896–903.

Fukuoka K, Nakaao K, Morimoto H, Nakao A, Takatori Y, Arimoto K, et al. Glycated albumin levels predict long-term survival in diabetic patients undergoing haemodialysis. Nephrology (Carlton) 2008;13(4):278–83.

Nakao T, Matsumoto H, Okada T, Han M, Hidaka H, Yoshino M, et al. Influence of erythropoietin treatment on hemoglobinA1c levels in patients with chronic renal failure on hemodialysis. Intern Med 1998;37(10):826–30.

Uzu T, Hatta T, Deji N, Izumiya T, Ueda H, Miyazawa I, et al. Target for glycemic control in type 2 diabetic patients on hemodialysis: effects of anemia and erythropoietin injection on hemoglobin A1c. Ther Apher Dial 2009;13(2):89–94.

Sany D, Elshahawy Y, Anwar W. Glycated albumin versus glycated hemoglobin as glycemic indicator in hemodialysis patients with diabetes mellitus: variables that influence. Saudi J Kidney Dis Transpl 2013;24(2):260–73.

Hoshino J, Molnar MZ, Yamagata K, Unara Y, Takaichi K, Kovesdy CP, et al. Developing an HbA1c-Based Equation to Estimate Blood Glucose in Maintenance Hemodialysis Patients. Diabetes Care 2013;36(4):922–7.

Williams ME, Lacson E Jr, Teng M, Ofsthun N, Lazarus JM. Hemodialyzed type I and type II diabetic patients in the US: Characteristics, glycemic control, and survival. Kidney Int 2006;70(8):1503–9.

Ryan TP. Sample Size Determination and Power. New Jersey: John Wiley & Sons; 2013.

Abe M, Matsumoto K. Glycated hemoglobin or glycated albumin for assessment of glycemic control in hemodialysis patients with diabetes? Nat Clinc Pract Nephrol 2008;4(9):482–3.

Chujo K, Shima K, Tada H, Oohashi T, Minakuchi J, Kawashima S. Indicators with blood glucose control in diabetics with End-stage chronic renal disease: GHb vs. Glyvated albumin (GA). J Med Invest 2006;53(3-4):223–8.