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The Use of Glycosylated Hemoglobin in Dialysis Patients

The development of renal failure in a diabetic alters insulin kinetics, tissue resistance to insulin, caloric intake, and other determinants of blood glucose control. Together with other diabetic complications such as gastroparesis and congestive heart failure these changes may make glucose control more difficult to manage in advanced renal failure (1). In retrospective studies, poor glycemic control during the dialysis period was associated with worse outcomes (3-5); however, whether the poor glycemic control was the cause or the consequence of complications such as severe heart failure, gastroparesis, and leg gangrene is uncertain. While convincing evidence supporting the value of good glycemic control in diabetics on dialysis is lacking, optimal diabetic control should be one of the aims of treatment for all diabetics including those starting dialysis. The purpose of this review is to assess the use of glycosylated hemoglobin as an index of glycemic control in diabetics on dialysis.