Diabetol Metab Syndr. 2026 Jan 24. doi: 10.1186/s13098-025-02067-y. Online ahead of print.
ABSTRACT
BACKGROUND: The reliability of hemoglobin A1c (HbA1c) as a glycemic marker is limited in chronic kidney disease (CKD), which has led to increased interest in glycated albumin (GA). This study aimed to compare the associations of GA and HbA1c with mortality.
METHODS: This prospective study used data from the National Health and Nutrition Examination Survey (1999-2004). Cox proportional hazards regression analysis with weight adjustment and restricted cubic spline regression were used to examine the associations between GA/HbA1c and mortality. The discriminative performance of GA and HbA1c for mortality was assessed via the concordance index (C-index), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).
RESULTS: A total of 1,532 (62.97%) all-cause deaths and 473 (19.44%) cardiovascular (CV) deaths among the 2,433 participants with CKD occurred over a median of 12.46 years of follow-up. The associations between GA and all-cause mortality as well as CV mortality showed a positive linear pattern (Pnonlinearity = 0.18 and 0.29, respectively), whereas HbA1c exhibited a U-shaped relationship (Pnonlinearity = 0.02 for all-cause mortality and 0.04 for CV mortality). GA showed higher C-index values than HbA1c in the associations with both all-cause (C-index: 0.60 (95% CI 0.59-0.62) vs. 0.55 (95% CI 0.53-0.57), P < 0.001) and CV mortality (C-index: 0.62 (95% CI 0.60-0.64) vs. 0.56 (95% CI 0.53-0.58), P < 0.001), particularly in early CKD patients. However, no difference existed in advanced CKD patients. Compared with HbA1c, adding GA to the existing risk models resulted in a greater C-index and significant improvements in the NRI and IDI for their associations with all-cause mortality. (Framingham CVD Risk Score + GA: C-index, 0.70; Framingham CVD Risk Score + HbA1c: C-index, 0.69, P = 0.04; NRI, 20% (95% CI 1%-36%); IDI, 0.3% (95% CI 0.3%-0.6%); Framingham Heart Age, C-index 0.68 vs. 0.67 (P = 0.04); NRI 12% (95% CI 3%-24%); IDI 1.3% (95% CI 0.5%-2.3%). Similar patterns were observed for CV mortality.
CONCLUSIONS: GA is more strongly associated with mortality than HbA1c in patients with CKD, particularly in the early stages, highlighting its potentially complementary value in clinical practice.
PMID:41580859 | DOI:10.1186/s13098-025-02067-y