Abstract: Aim: To investigate the association between hemoglobin (Hb) levels and incident diabetic kidney disease (DKD) in patients with type 2 diabetes.
Methods: This retrospective cohort study included 1,657 patients with diabetes, without DKD at baseline, recruited from six clinics affiliated with Lee's United Clinic in Taiwan. Demographic data and laboratory results were collected and analyzed. Participants were stratified into quartiles based on their baseline Hb levels. A subgroup analysis was conducted specifically for patients with normal Hb levels (men: Hb ≥ 120 g/l, women: Hb ≥ 110 g/l). Cox regression analysis assessed the relation between Hb levels and incident DKD, adjusting for relevant covariates.
Results: Among the initial cohort, 93 (5.6 %) had anemia at baseline. Over an average follow-up period of 5.7 ± 2.6 years, 594 patients (35.8 %) developed DKD. Cox regression analysis revealed that, after adjusting for multiple variables, compared with patients in the highest quartile of baseline Hb levels (Q4: Hb ≥ 154 g/l), the hazard of DKD was 1.6 times higher in the lowest quartile (Q1: Hb ≤ 130 g/l) HR [95 % CI] 1.58 [1.19;2.21] P < 0.001. In patients with normal Hb levels, Cox regression analysis also revealed that compared to the highest quartile (Q'4, Hb ≥ 154 g/l) the hazard of developing DKD was 1.3 times higher in the lowest quartile (Q'1, Hb ≤ 132 g/l) HR [95 % CI ] 1.29 [1.08;1.72] P = 0.042.
Conclusions: Lower Hb is associated with incident DKD, even in patients with normal Hb levels, independent of other risk factors.
Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare. We certify that all authors have participated sufficiently in the work to take public responsibility for the appropriateness of the study design and method, collection, analysis, interpretation of the data and the manuscript drafting and revision. Qingqing Lou conceived and designed the study. Yetong Wang, Fangli Tang, Huanhuan Liu and Yau-Jiunn Lee collected the epidemiological and clinical data. Qingqing Lou, Wenjun Wang, Yetong Wang, Fangli Tang contributed to analysis and interpretation of data. Qingqing Lou, WenjunWang and Yetong Wang drafted the manuscript. Qingqing Lou contributed to critical revision of the manuscript for important intellectual content. All authors read, revised, and approved the final draft. Qingqing Lou are the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All investigators are independent from funders.
(Copyright © 2024. Published by Elsevier Masson SAS.)
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