Hemoglobina A1c, diabetes mellitus, nefropatía diabética y enfermedad renal crónica

Alicia G. Cercado, Graciela B. Álvarez Conde, Mariana E. Guadalupe Vargas, Betty J. Pazmiño Gómez, Dolores Veron, Fanny E. Vera Lorenti, Edgar I. Rodas Neira, Enrique Fariño, Maitén Fernández Veron, Vicenta Cevallos, Guillermo Villegas, Elvira Arrizurieta, Delma Veron

Resumen


La diabetes mellitus (DBT), la nefropatía diabética (ND) y la enfermedad renal crónica (ERC) son enfermedades prevalentes en nuestra región, Sudamérica. Los niveles de hemoglobina A1c (HbA1c) han sido relacionados al desarrollo y a la evolución de la ND. Hace dos décadas había gran variabilidad en los resultados, Los países líderes en investigación científica organizaron programas de estandarización de la HbA1c, logrando mejorar la calidad y la confiabilidad de los resultados. Los objetivos de este trabajo fueron describir el problema DBT, ND y ERC en Sudamérica y en su contexto analizar metodológicamente la HbA1c. Para esto, revisamos el impacto de estas enfermedades en nuestra región, contemplando aspectos básicos de la HbA1c y algunas situaciones que producen interferencias como la carbamilación de la hemoglobina, modificación post-traduccional asociada a la uremia. También nos enfocamos en técnicas estadísticas universalmente utilizadas para la evaluación de ensayos como: linealidad, concordancia y precisión. Adicionalmente, incluimos un análisis de los métodos disponibles y de los precios de cada determinación de HbA1c en diez países de Sudamérica.
Para prevenir, diagnosticar y tratar la DBT, la ND y la ERC es indispensable contar con herramientas de última generación, disponibles para todas las personas. En nuestra región el acceso a ensayos, equipos y laboratorios enmarcados en programas de estandarización de la HbA1c, internacionalmente aceptados, es una tarea pendiente. Millones de individuos de las generaciones presentes y futuras de Sudamérica padecerán DBT, ND y ERC, necesitamos llevar la voz de la ciencia a esas personas con el “hacer” cotidiano.


Palabras clave


HbA1c; diabetes mellitus; nefropatía diabética; enfermedad renal crónica; métodos; concordancia; precisión; costos

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