Accuracy, Variability, and Bias of Glycemic Biomarkers in Patients Treated With Maintenance Dialysis
Authors' conclusion
HbA1c and GA were strongly correlated with mean CGM blood glucose, but all biomarkers had substantial bias by relevant clinical characteristics. HbA1c and GA may be useful assessments of average glycemia in patients treated with maintenance dialysis, if bias can be adequately addressed.
Study context
- Population
- People with and without diabetes treated with maintenance dialysis; 43% women, 63% with diabetes
- Participants
- 251 people
- Exposure
- HbA1c, glycated albumin (GA) and fructosamine vs continuous glucose monitor (CGM)-derived mean glycemia
- Outcome
- Correlation with mean CGM glucose (overall)
Methodological detailscommunity-based
- Community-based
Main finding
As reported in the abstract
| Group | R |
|---|---|
| HbA1c | 0.85 |
| GA | 0.87 |
| Fructosamine | 0.70 |
R
HbA1c0.85
GA0.87
Fructosamine0.70
Observational data: associations, not effects.
Further findings
| Outcome | HbA1c | GA | Fructosamine |
|---|---|---|---|
| Correlation with mean CGM glucose in diabetes | |||
| R | 0.84 | 0.84 | 0.64 |
| Biomarker levels | mean 6.2 (SD 1.4%) % | mean 19.6 (SD 6.3%) % | mean 351 (SD 99) µmol/L |
- Biomarker levels: CGM mean 170 (SD 63) mg/dL
Bias vs mean CGM glucose
- HbA1c significantly biased by erythropoiesis-stimulating agent dose, BMI, hemoglobin and serum albumin
- GA and fructosamine biased by dialysis modality and vintage, residual kidney function and BMI
Valid CGM days
- Median valid days of CGM data
- 9.3 (IQR 8.5-9.4)
Original publication
Accuracy, Variability, and Bias of Glycemic Biomarkers in Patients Treated With Maintenance Dialysis. Diabetes Care. Published 10 March 2026. doi:10.
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