Galindo RJ, Beck RW, Scioscia MF, et al. - Since wide glycemic excursions are commonly encountered by patients with end stage kidney disease, and both hypoglycemia and hyperglycemia are common, researchers focused on glycemic monitoring as well as treatment in advanced chronic kidney disease. They noted that a variety of CKD-related conditions hinder the evaluation of glycemia by glycated hemoglobin (HbA1c), these can bias the measure either to the low or high range. Even less reliability is shown by alternative glycemic biomarkers, such as glycated albumin or fructosamine, compared with HbA1c. Thus, the preferred glycemic biomarker is HbA1c despite its limitations. Taking into account the observational data for links with death and risks of hypoglycemia with intensive glycemic control regimens in advanced CKD, a HbA1c range of 7-8% seems to be most favorable. A more precise monitoring and treatment adjustments, with the help of continuous glucose monitoring in this population, may allow fine-tuning of glycemic management in patients with diabetes and advanced CKD.