Performance of non‐traditional hyperglycemia biomarkers by chronic kidney disease status in older adults with diabetes: Results from the Atherosclerosis Risk in Communities Study

Molly Jung, Bethany Warren, Morgan Grams, Yuenting D. Kwong, Tariq Shafi, Josef Coresh, Casey M. Rebholz, Elizabeth Selvin

In persons with chronic kidney disease (CKD), hemoglobin A1c (HbA1c) may be a problematic measure of glycemic control. Glycated albumin and fructosamine have been proposed as better markers of hyperglycemia in CKD. We investigated associations of HbA1c, glycated albumin, and fructosamine with fasting glucose by CKD categories. Cross-sectional analysis of 1,665 Atherosclerosis Risk in Communities Study participants with diagnosed diabetes aged 65 years or older. We compared Spearman's rank correlations (r) and used Deming regression to obtain root mean square errors (RMSEs) for the associations across CKD categories defined using estimated glomerular filtration rate and urine albumin-to-creatinine ratio. Correlations of HbA1c, glycated albumin, and fructosamine with fasting glucose were lowest in persons with severe CKD (HbA1c r=0.52, RMSE=0.91; glycated albumin r=0.39; RMSE=1.89; fructosamine r=0.41; RMSE=1.87) and very severe CKD (r=0.48 and RMSE=1.01 for HbA1c; r=0.36 and RMSE=2.14 for glycated albumin; r=0.36 and RMSE=2.22 for fructosamine). Associations of glycated albumin and fructosamine with HbA1c were relatively similar across CKD categories. In older adults with severe or very severe CKD, HbA1c, glycated albumin, and fructosamine were not highly correlated with fasting glucose. Our results suggest there may be no particular advantage of glycated albumin or fructosamine over HbA1c for monitoring glycemic control in CKD.