Glycosylated haemoglobin in renal failure

Diabetologia, Aug 1981

M. Oimomi, K. Ishikawa, T. Kawasaki, S. Kubota, Y. Yoshimura, S. Baba

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Glycosylated haemoglobin in renal failure

Glycosylated Haemoglobin in Renal Failure 0 Dr. Munetada Oimomi Second Department of Internal Medicine Kobe University School of Medicine Ikuta-ku Kobe , 650 , Japan 1 Yours sincerely, M. Oimomi, K. Ishikawa , T. Kawasaki, S. Kubota, Y. Yoshimura and S. Baba Dear Sir, De Boer et al. [1] reported that levels of glycosylated haemoglobin [HbA1] were elevated in patients with renal failure. On the other hand, Dandona et al. [2] reported that HbA 1 levels were decreased in patients with renal failure because of the shortened life-span of erythrocytes. In a recent publication in Diabetologia, Graf et al. [3] performed glucose tolerance tests in order to investigate the relationship between glucose tolerance and HbA 1in renal failure. They found an elevation of HbA 1 levels which did not correlate with the degree of impaired glucose tolerance. We ]xave also investigated whether or not the elevation of HbA 1 values in patients with renal failure was related to impaired glucose tolerance using high-performance liquid chromatography, the microcolumn method, and the thiobarbituric acid colorimetric test [4] for the measurement of t-IbA1. The high-performance liquid chromatographic quantification of components of the HbA l fraction showed that, in diabetic patients, the increase of HbAlc was mainly due to an increase in the HbAlc fraction (Table 1). In contrast, patients with renal failure showed increases not only in HbA1, but also in the HbAla+b fractions. Thus, the fractional pattern of HbA 1 in patients with renal failure was similar to that seen in normal subjects rather than in diabetic patients. In another study, we have estimated HbA I levels in diabetic patients, in patients with renal failure and in normal subjects using the colorimetric method in which compounds generated from glycosylated haemoglobin on heating under acidic conditions were determined colorimetrically with thiobarbituric acid. These results were compared with data obtained by the microcolumn technique (Fig. 1). - 14" ~, HbAI 13" lx 11" 10" 9" 8" z~z~ A. z~ ix z3, I 1O0 zx z~ z~ A ii o A o o ~ o(~O o o o TBAt o o o o o I 200 % Normal subjects (n = 12) Diabetics (n = 21) Uraemic patients (n = 16) Haemoglobin A 1 a + b a + b + c 2 . 6 _ + 0 . 1 4.6_+0.2 7.2_+0.2 36.1_+1.0 3.6k0.2 a 9.4_+0.8a 12.9+1.0 a 28.2-+0.9 a 3.5 a 5.9_+0.2b 9.4 a 37.2_+0.9 The results represent the mean _+ SEM There is a significant difference between normal subjects and patients with diabetes or uraemia (a p < 0.001; up < 0.005) In diabetic patients, there was a positive correlation between HbA 1 values obtained by the microcolumn method and those obtained by the thiobarbituric acid method. In patients with renal failure, however, no correlation was noted between the results obtained by the two methods. According to the thiobarbituric acid method, patients with renal failure showed I-IbA1 levels similar to those observed in normal subjects. These findings strongly suggest that HbA t in patients with renal failure might be the result of binding of something other than glucose to haemoglobin. 1. De Boer M-J , Miedema K , Casparie AF ( 1980 ) Glycosylated haemoglobin in renal failure . Diabetologia 18 : 437 - 440 2. Dandona P , Freedman D , Moorhead JF ( 1979 ) Glycosylated haemoglobin in chronic renal failure . Br Med J I: 1183 - 1184 3. Graf H , Stummvoll HK , Schernthaner G , Miiller MM ( 1980 ) Glycosycosylated haemoglobin in renal failure . Diabetologia 19 : 555 - 556 4. Gabbay KH , Sosenko JM , Banuchi GA , Mininsohn MJ , Fliikiger R ( 1979 ) Glycosylated hemoglobin: Increased glycosylation of hemoglobin A in diabetic patients . Diabetes 28 : 337 - 340

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M. Oimomi, K. Ishikawa, T. Kawasaki, S. Kubota, Y. Yoshimura, S. Baba. Glycosylated haemoglobin in renal failure, Diabetologia, 1981, 163-163, DOI: 10.1007/BF00251288