| [ Summary ] |
Patients with diabetes undergoing dialysis for a presumptive diagnosis of diabetic nephropathy show spontaneous improvement in glycemic control with the progression of chronic kidney disease, loss of residual kidney function, and the initiation of dialysis therapy, leading to normal-to-low levels of glycated hemoglobin (HbA1c) and glucose regardless of treatment. This commonly observed phenomenon is referred to as "burnt-out diabetes." Higher HbA1c values are incrementally associated with a higher risk of death after adjusting for demographic factors and other confounders. Low HbA1c values (particularly values<5 %) are also associated with poor survival. Red blood cells show a shorter life span in patients undergoing hemodialysis (HD), and blood loss and hemorrhage may occur during HD. Thus, by increasing the percentage of young erythrocytes in the blood, both, anemia and erythropoiesis-stimulating agents can falsely lower HbA1c levels, and hyperglycemia can be missed in such cases. Reportedly, "burnt-out diabetes" (defined as HbA1c<6.0 % without treatment with antidiabetic medications) was diagnosed in 4,899 patients (20.7 %) of 23,668 Japanese patients undergoing HD. However, when "burnt-out diabetes" was defined in terms of HbA1c<6.0 % and glycated albumin (GA)<16.0 % without treatment with antidiabetic medication, it was diagnosed in 1,286 patients (5.4 %). Although the "burnt-out diabetes" phenomenon occurred in 20.7 % of patients with diabetes undergoing HD when defined in terms of HbA1c, the rate was significantly decreased to 5.4 % when it was defined in terms of GA. |