BACKGROUND: Monitoring of glycemic control with hemoglobin A1c (A1c) in 
hemodialysis patients may be compromised by anemia and erythropoietin therapy. 
Glycated albumin (GA) is an alternative measure of glycemic control but is not 
commonly used because of insufficient evidence of association to clinical 
outcomes. We tested whether GA measurements were associated with mortality in 
hemodialysis patients with diabetes mellitus.
METHODS: The German Diabetes and Dialysis Study (4D) investigated effects of 
atorvastatin on survival in 1255 patients with diabetes mellitus receiving 
hemodialysis. We measured GA during months 0, 6, and 12. Cox proportional 
hazards analysis was used to measure associations between GA and A1c and 
all-cause mortality.
RESULTS: Patients with high baseline GA (fourth quartile) had a 42% higher 
4-year mortality compared to those in the first quartile (HR 1.42; 95% CI, 
1.09-1.85, P = 0.009). Repeated measurements of GA during year one also 
demonstrated that individuals in the top quartile for GA (analyzed as a 
time-varying covariate) had a 39% higher 4-year mortality (HR 1.39; 95% CI, 
1.05-1.85, P = 0.022). The associations between high A1c and mortality using 
similar analyses were less consistent; mortality in individuals with baseline 
A1c values in the 3rd quartile was increased compared to 1st quartile (HR 1.36; 
95% CI, 1.04-1.77, P = 0.023), but risk was not significantly increased in the 
2nd or 4th quartiles, and there was a less consistent association between 
time-varying A1c values and mortality.
CONCLUSIONS: High GA measurements are consistently associated with increased 
mortality in patients with diabetes mellitus on hemodialysis.