Chapter 2: Metabolic control in different stages of chronic kidney disease
DOI:
https://doi.org/10.47196/diab.v58i2Sup.783Keywords:
diabetes mellitus, glycemic control, chronic kidney diseaseAbstract
In the population with diabetes mellitus (DM) and chronic kidney disease (CKD), glycemic control may be subject to conditions that make its compliance difficult, considering that in advanced stages of CKD they frequently experience greater “glycemic variability” (GV).
Metabolic evaluation measured by HbA1c1,2 is altered by conditions associated with CKD.
The evidence suggests that glycated albumin (GA) would be a glycemic marker and prognostic factor superior to fructosamine and HbA1c in populations in stage (E) 4-5 of CKD or in hemodialysis treatment (HD), there being insufficient data regarding of the usefulness of these parameters in early stages of CKD and in peritoneal dialysis (PD). In the event of alterations in albumin metabolism (e.g., proteinuria in the nephrotic range), the results should be interpreted with caution3.
Due to the aforementioned limitations, HbA1c continues to be used as a reference for glycemic control, always considering these limitations.
Self-glycemic monitoring (SMG) is associated with erroneous readings due to the presence of hypoxia, hypertriglyceridemia, hyperuricemia or increased bilirubin4. It does not detect the presence of asymptomatic or nocturnal hypoglycemia, and does not provide dynamic information on variations in blood glucose levels.
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