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Glycaemic Monitoring in Dialysis — ESENeph MCQ

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HardDiabetic Kidney DiseaseGlycaemic Monitoring in DialysisESENeph

A patient on haemodialysis receives an erythropoiesis-stimulating agent. HbA1c is 43 mmol/mol, but repeated pre-dialysis glucose values are 12–16 mmol/L and CGM shows a mean glucose of 11.8 mmol/L. What is the best interpretation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — HbA1c is probably falsely low; treatment decisions should incorporate CGM or direct glucose data

Explanation lettering: C = shown as A · A = shown as C

B is correct. HbA1c becomes less reliable in advanced CKD, especially dialysis. Shortened erythrocyte survival, blood loss, transfusion and stimulation of new red cells by an ESA can lower HbA1c relative to prevailing glycaemia. The repeated capillary values and CGM pattern are concordant and should therefore influence management rather than being dismissed. CGM has its own limitations, including lag and device-specific accuracy, but it is specifically useful when HbA1c and measured glucose disagree. The pattern does not by itself diagnose a haemoglobin variant or demonstrate hypoglycaemia.

Reference: KDIGO 2022 guideline for diabetes management in CKD: https://kdigo.org/wp-content/uploads/2022/10/KDIGO-2022-Clinical-Practice-Guideline-for-Diabetes-Management-in-CKD.pdf