Kidney Week Early 2025 Program - Diabetes Management for the Nephrology Care Team: New Technology and New Drugs-The Good, the Bad, and the Ugly: Biomarkers to Assess Average Blood Glucose

Video Transcription

Video Summary

Dr. Lila Zelnick, a biostatistician, reviews biomarkers used to estimate average blood glucose in people with chronic kidney disease (CKD) and kidney failure, using mean continuous glucose monitor (CGM) glucose as the practical “gold standard.” She explains that HbA1c is widely used and supported by trial evidence in the general diabetes population, but becomes problematic in advanced CKD—especially in hemodialysis—because it can be falsely low. Key mechanisms include shortened red blood cell lifespan, dialysis-related red cell damage, and treatments like erythropoiesis-stimulating agents (ESAs) and IV iron that increase young red cells with less time for glycation.<br /><br />She contrasts HbA1c with alternative markers: fructosamine (2–3 week glycemia) and glycated albumin (3–5 weeks), which avoid red-cell bias but are affected by protein turnover (e.g., hypoalbuminemia, proteinuria, cirrhosis) and lack standardized assays and outcome-based treatment targets.<br /><br />Data from the CANDY (CKD) and BLOSUM (maintenance dialysis) studies show biomarkers correlate reasonably well with CGM (good precision) but have predictable biases (e.g., ESA dose, dialysis modality, albumin). She argues this combination—low variance with known bias—suggests future potential for bias-corrected biomarkers. A case example shows a dialysis patient with HbA1c 5.8% but CGM-implied glycemia closer to 8.4%, highlighting risk of mismanagement if relying on HbA1c alone.

Asset Subtitle

Leila Zelnick

Meta Tag

Module DKD

Speaker Leila Zelnick

Keywords

chronic kidney disease

hemodialysis

HbA1c bias

continuous glucose monitoring

fructosamine

glycated albumin

erythropoiesis-stimulating agents