Assessment of hemoglobin A1c in hemodialysis patients with diabetes before and after erythropoietin treatment

Hemoglobin A1c (HbA1c) remains the most widely utilized laboratory marker for assessing long-term glycemic control. However, its reliability as a metabolic indicator in diabetic patients (DM) undergoing hemodialysis (HD) and receiving erythropoietin (EPO) therapy continues to be a subject of ongoing debate, primarily due to altered erythrocyte turnover characteristic of this patient population. To assess EPO treatment effect on HbA1c levels and its reliability as a glycemic marker in diabetic patients undergoing regular HD. This prospective cohort study was carried out on 80 patients with renal disease undergoing regular HD, both prior to and following a three-month course of EPO therapy. Participants were stratified into two groups: Group I (n = 40) comprised EPO-naïve diabetic patients on regular HD, while Group II (n = 40) consisted of EPO-naïve non-diabetic patients receiving same treatment. All patients underwent clinical evaluation, comprehensive laboratory testing, and HbA1c assessment at baseline and after three months of EPO administration. At baseline, Group I showed significantly higher HbA1c (7.5 ± 0.61% vs. 4.4 ± 0.68%, P < 0.001), fasting insulin, and HOMA-IR relative to Group II. After EPO therapy, HbA1c significantly declined in Group I (to 5.2 ± 0.61%, P < 0.001) without significant changes in FBG. HbA1c demonstrated a significant moderate negative correlation with Hb levels post-EPO in both groups (r = -0.585, P < 0.001, Group II). HbA1c proved to be an unreliable indicator of glycemic control in this patient population, as EPO therapy in diabetic individuals undergoing regular HD was associated with a notable reduction in HbA1c levels, despite the absence of a corresponding change in FBG and a lack of direct correlation between HbA1c and FBS.