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Background <p>Hemoglobin A1c (HbA1c) remains the most widely utilized laboratory marker for assessing long-term glycemic control. However, its reliability as a metabolic indicator in diabetic patients (DM) undergoing hemodialysis (HD) and receiving erythropoietin (EPO) therapy continues to be a subject of ongoing debate, primarily due to altered erythrocyte turnover characteristic of this patient population.</p> Objectives <p>To assess EPO treatment effect on HbA1c levels and its reliability as a glycemic marker in diabetic patients undergoing regular HD.</p> Methods <p>This prospective cohort study was carried out on 80 patients with renal disease undergoing regular HD, both prior to and following a three-month course of EPO therapy. Participants were stratified into two groups: Group I (<i>n</i> = 40) comprised EPO-naïve diabetic patients on regular HD, while Group II (<i>n</i> = 40) consisted of EPO-naïve non-diabetic patients receiving same treatment. All patients underwent clinical evaluation, comprehensive laboratory testing, and HbA1c assessment at baseline and after three months of EPO administration.</p> Results <p>At baseline, Group I showed significantly higher HbA1c (7.5 ± 0.61% vs. 4.4 ± 0.68%, <i>P</i> &lt; 0.001), fasting insulin, and HOMA-IR relative to Group II. After EPO therapy, HbA1c significantly declined in Group I (to 5.2 ± 0.61%, <i>P</i> &lt; 0.001) without significant changes in FBG. HbA1c demonstrated a significant moderate negative correlation with Hb levels post-EPO in both groups (<i>r</i> = -0.585, <i>P</i> &lt; 0.001, Group II).</p> Conclusions <p>HbA1c proved to be an unreliable indicator of glycemic control in this patient population, as EPO therapy in diabetic individuals undergoing regular HD was associated with a notable reduction in HbA1c levels, despite the absence of a corresponding change in FBG and a lack of direct correlation between HbA1c and FBS.</p>

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Assessment of hemoglobin A1c in hemodialysis patients with diabetes before and after erythropoietin treatment

  • 期刊论文

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  • 发表日期：

    2025年11月12日

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  • Amira K. El-Alfy,
  • Fawzy Megahed Khalel,
  • Mohamed Abd Elmaged Ahmed,
  • Mai Alsoudy Ali Baraka,
  • Ahmed Refaat Mohamed

摘要

Background

Hemoglobin A1c (HbA1c) remains the most widely utilized laboratory marker for assessing long-term glycemic control. However, its reliability as a metabolic indicator in diabetic patients (DM) undergoing hemodialysis (HD) and receiving erythropoietin (EPO) therapy continues to be a subject of ongoing debate, primarily due to altered erythrocyte turnover characteristic of this patient population.

Objectives

To assess EPO treatment effect on HbA1c levels and its reliability as a glycemic marker in diabetic patients undergoing regular HD.

Methods

This prospective cohort study was carried out on 80 patients with renal disease undergoing regular HD, both prior to and following a three-month course of EPO therapy. Participants were stratified into two groups: Group I (n = 40) comprised EPO-naïve diabetic patients on regular HD, while Group II (n = 40) consisted of EPO-naïve non-diabetic patients receiving same treatment. All patients underwent clinical evaluation, comprehensive laboratory testing, and HbA1c assessment at baseline and after three months of EPO administration.

Results

At baseline, Group I showed significantly higher HbA1c (7.5 ± 0.61% vs. 4.4 ± 0.68%, P < 0.001), fasting insulin, and HOMA-IR relative to Group II. After EPO therapy, HbA1c significantly declined in Group I (to 5.2 ± 0.61%, P < 0.001) without significant changes in FBG. HbA1c demonstrated a significant moderate negative correlation with Hb levels post-EPO in both groups (r = -0.585, P < 0.001, Group II).

Conclusions

HbA1c proved to be an unreliable indicator of glycemic control in this patient population, as EPO therapy in diabetic individuals undergoing regular HD was associated with a notable reduction in HbA1c levels, despite the absence of a corresponding change in FBG and a lack of direct correlation between HbA1c and FBS.