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1. Clin Chim Acta. 2012 May 10. [Epub ahead of print]

Glycated albumin in diabetic patients with chronic kidney disease.

Zheng CM, Ma WY, Wu CC, Lu KC.

Division of Nephrology, Department of Medicine, Shuang-Ho Hospital, Taipei
Medical University, Taipei, Taiwan.

Chronic hyperglycemia results in a non-enzymatic glycation of proteins, and
produces Amadori products, such as glycated albumin (GA), glycosylated hemoglobin
(HbA1c), and fructosamine. In current clinical practice, long-term glycemic
control is assessed by quarterly measurements of HbA1c. Since the degree of
hemoglobin glycosylation depends not only on the level of glycemic control, but
also on the lifespan of red blood cells, patients with hemoglobin disorders or
anemia of any cause may have erroneous HbA1c levels, and consequently receive
insufficient treatment. Patients with chronic kidney disease (CKD) often suffer
from various types of anemia, and consequently, they are frequently treated with
iron and/or erythropoietin therapy or frequent blood transfusion. Thus, serum GA
is a potentially useful glycemic index in diabetic patients with CKD, since it is
not influenced by anemia and associated treatments. GA may also reflect the
status of blood glucose more rapidly (2-3weeks) than HbA1c (2-3months), and is
beneficial in those with wide variations in blood glucose or at higher risk for
hypoglycemia. If clinical investigations support its utility, it may be
applicable as a screening tool for all patients with diabetes during routine
health examinations. Serum GA levels are also associated with AGE-related
fluorescence and the number of glycation sites, and it may influence the
structural and functional changes inalbumin. Since end-stage renal disease is an
extreme microvascular complication of diabetic nephropathy, CKD patients with
diabetes should be carefully managed to prevent disease progression. In this
review, the clinical aspects of GA were discussed, including a comparison of GA
with other glycated proteins, the utility and limitations of GA as a glycemic
index, its influence on the therapeutic effects of hypoglycemic agents, its
correlations with vascular complications, and its potential role in pathogenesis,
specifically in diabetic patients with CKD.

Copyright © 2012 Elsevier B.V. All rights reserved.

PMID: 22579765 [PubMed - as supplied by publisher]