Association between liver and chronic kidney disease on hemoglobin A1c concentrations

•Patients with high AST, ALT levels and chronic kidney disease can have increased hemoglobin A1c levels.•There is a relationship between eGFR, CKD staging, and mean HbA1c levels. The trend demonstrates an inverse relationship between decreasing mean eGFR and increasing mean HbA1c measurements through Stage 1–3 CKD. As mean eGFR decreases further to Stage 4–5 CKD, the mean HbA1c decreases rather than increases.•Clinicians should consider liver and kidney disease status before making any therapeutic decisions when monitoring A1c levels. HbA1c is the gold standard for measuring long-range glycemic control in patients with type-2 diabetes mellitus. Conditions such as CKD or LD can lead to spurious HbA1c test results. There is conflicting literature about the relationship between HbA1c, LD, and CKD. Results for HbA1c concentrations were retrieved from 2015- to 2019. We evaluated over 2,500 test results with LD and 20,000 results with CKD compared to over 21,000 test results without LD, iron deficiency anemia, or CKD. Patients were classified as having LD if they had high ALT and AST concentrations and classified as CKD, if they have abnormal serum creatinine and BUN or low eGFR based on age-based reference ranges. Kruskal–Wallis statistical analyses method was used to test whether the two populations followed the same distribution and significance. The median HbA1c concentration was 5.8% (40 mmol/l) among LD classified patients in both males and females vs. 5.4% (36 mmol/l) (P