This content originally appeared diatribe. It was reissued with permission.
by Anna Widowsky and Matthew Garza
Medical review Charles M. Alexander, Maryland, FACP, Faith
Important takeouts:
- Diabetes is the main cause of chronic kidney disease, a condition in which the kidneys gradually lose their ability to function over time.
- Chronic kidney disease can lead to inaccurate measurements of A1C due to anemia and altered red blood cell production, which may lead to A1C being less reliable in blood glucose monitoring.
- Alternative solutions such as continuous glucose monitoring and time of range may provide more accurate insight into glycemic control.
Chronic kidney disease is the main complications It is particularly associated with diabetes, where measurements of A1C can be inaccurate, especially at advanced stages. If you have kidney disease, for some reason, we will explore what you can do to manage your blood sugar levels.
According to Centers for Disease Control and Prevention (CDC)diabetes is one of the main causes Chronic kidney diseaseIt is also known as diabetic kidney disease. Other risk factors include hypertension, a family history of kidney disease, obesity, and heart disease. Approximately one in three adults with diabetes may have chronic kidney disease, and many are unaware that they have it. Early stage kidney disease is often not symptomatic, so it is important to check your kidney health regularly. Medical professionals use urine combinations Blood test Check kidney function.
Treatment of diabetic kidney disease also includes treating chronically hyperglycemic levels, the underlying cause. A1C is an important measure used to assess overall diabetes management and risk of complications, but it has some limitations. Since A1c One value that estimates glucose levels over the past 2-3 months is one that does not provide or notify you of any details about daily glucose trends. Hypoglycemia (Hypoglycemia). If someone has chronic kidney disease, the accuracy of the A1C values may be compromised.
It is important to consult with your healthcare provider about some of the challenges and limitations of A1C. Additional measurements such as Range time Use continuous glucose monitoring (CGM) with your healthcare team.
What is chronic kidney disease and how does it relate to diabetes?
The kidneys are an important organ in our body that causes several important functions, including:
- Remove waste from blood and other body fluids
- Balance the fluids and salts in the body
- Helps in managing your blood pressure
- Activate Vitamin dHelps keep your bones healthy
- Helps to produce hormones that stimulate the bone marrow to produce red blood cells
Chronic hyperglycemia levels, along with hypertension, can damage the small vascular filtering system of the kidneys, leading to renal failure.
Standard for most people with chronic kidney disease process It focuses on lifestyle modifications and slowing disease progression with blood pressure lowering medications. but, Recent research We have shown that treatment with SGLT-2 and GLP-1 drugs that help lower blood glucose provides additional kidney and heart benefits. This is especially true for people with diabetes, but SGLT-2 drugs Not approved By FDA in individuals with type 1 diabetes. SGLT-2 drugs have been added in recent years Treatment Guidelines As an important disease modifier therapy for people with type 2 diabetes and chronic kidney disease.
How does chronic kidney disease affect A1C in diabetic patients?
Recent the study A1C as a measure of glucose control indicates low accuracy for chronic kidney disease, particularly those with advanced chronic kidney disease (meaning renal function or EGFR below 30) or those on dialysis.
A1C measures the amount of glucose bound to hemoglobin in red blood cells over time. In chronic kidney disease, the higher the level of waste in the blood, the more likely it is to affect the way glucose binds to these red blood cells. A1C measurements depend on both blood glucose levels and red blood cell lifespan, so A1C measurements may not be reliable due to poor kidney function.
Why chronic kidney disease can overestimate or underestimate a person's actual A1C? Kdigo Clinical Practice Guidelines. In some cases, chronic kidney disease can lead to A1C, which appears to be higher than it actually is. For example, when the kidneys begin to break down, the body cannot remove the acids that accumulate in its body. This accumulation of acid (labeled as “metabolic acidosis” in the figure) speeds up the process of glucose binding to hemoglobin, making A1C appear high even when blood glucose levels are actually low.
Chronic kidney disease, on the other hand, can also lead to A1C, which appears to be lower than it actually is. This is because kidney disease can reduce red blood cell production and lead to anemia (lower than usual red blood cell count). This means that even if blood glucose is actually high, there is less hemoglobin for glucose to bind.
Furthermore, blood transfusions and drugs can have the same effect, which help your body produce more alternative red blood cells. Therefore, if you have a diagnosis of diabetes and are at risk of developing kidney disease, it is important to discuss your A1C target with your healthcare team.
CGM and Automatic insulin delivery (AID) system. This helps track and manage your blood sugar levels.
If A1C is not reliable, how can you improve glycemic control for people with diabetes and chronic kidney disease?
meanwhile Clinical Treatment Guidelines It is recommended to use A1C to monitor blood glucose control in people with diabetes and chronic kidney disease. They recognize the limitations of A1C among people with chronic kidney disease.
Replenishing A1C with other measurements of glucose control, such as time within range, may help to draw a more accurate picture of an individual's blood glucose status. CGM also helps people monitor hypoglycemia by measuring time below a certain range of risk, as kidney failures and insulin decreases.
Further research into the use of CGM as a supplement to A1C is needed to help people with diabetes and chronic kidney disease to better understand how to improve glycemic control.
For more information about chronic kidney disease and diabetes, please see here.
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