Hemoglobina glicada (HbAa1c). Utilidad y limitaciones en pacientes con enfermedad renal crónica
Resumen
La diabetes tipo 2 (DM2) es uno de los grandes problemas de salud pública a nivel mundial y uno de los mayores desafíos del siglo XXI. La glucemia es un parámetro de laboratorio fácil de evaluar y ocupa un rol fundamental tanto en el diagnóstico como en el seguimiento de la DM. La determinación de proteínas glicadas, en especial la hemoglobina (HbA1c) y las proteínas séricas (fructosamina) permiten cuantificar el promedio de la misma a lo largo de semanas o meses, complementando el monitoreo glucémico. Los métodos que se implementan para lograr el control glucémico en la enfermedad renal crónica (ERC) se extrapolan de estudios con DM sin ERC, debido a la falta de evidencia de estudios randomizados de alta calidad en esta población. Se debe considerar que en ERC existen cambios metabólicos que determinan que la hemoglobina (Hb) presente comportamientos variables, motivo por el que surge la discusión de si la HbA1c constituye un marcador confiable para definir control glucémico o de utilidad en la predicción del desarrollo de complicaciones en esta subpoblación. Se presenta una revisión acerca del rol de la HbA1c en el paciente con DM sin ERC para luego mostrar las dificultades que se presentan en la subpoblación con ERC, centrándose especialmente en los pacientes en tratamiento de hemodiálisis y diálisis peritoneal.Citas
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