Babazono T, Hanai K, Suzuki K, Kiuchi Y, Inoue A, Tanaka M, Tanaka N, Hase M, Ishii A, Iwamoto Y
Division of Nephrology and Hypertension, Diabetes Centre, Tokyo Women's Medical University School of Medicine, 8-1 Kawadacho, Shinjukuku, Tokyo, 162-8666, Japan.
Diabetologia. 2006 Jun;49(6):1387-93. doi: 10.1007/s00125-006-0247-y. Epub 2006 Apr 13.
AIMS/HYPOTHESIS: Anaemia has been suggested to be an independent risk factor for subsequent progression of advanced diabetic nephropathy; however, the relationship between haemoglobin levels and progression of nephropathy in patients without clinical albuminuria is unknown.
We conducted this prospective hospital-based cohort study of 464 type 2 diabetic patients (149 women and 315 men, 55+/-13 [mean+/-SD] years of age) with serum creatinine <177 micromol/l (2.00 mg/dl) and urinary albumin : creatinine ratio <300 mg/g creatinine. GFR was estimated using the equation formulated by the Modification of Diet in Renal Disease Study group, refitted for Japanese individuals. Most patients had haemoglobin concentrations in the normal range (144+/-15 g/l), only modest renal impairment (GFR: 74.8+/-14.5 ml min(-1) 1.73 m(-2)), and normal urinary albumin levels (81.5/18.5% with normo-/microalbuminuria). The primary outcome measurement was the rate of change in GFR determined by regression analysis with GFR as a function of time. Patients were followed up for a mean observation period of 5.0+/-0.9 (range: 2.5 to 6.2) years.
Univariate and multiple regression analyses yielded a significant association between the rate of change in GFR and baseline haemoglobin concentration. After adjusting for covariates, the rate of decline in GFR was significantly greater in patients in the lowest haemoglobin quartile (-3.27 ml min(-1) 1.73 m(-2) year(-1)) than in the third (-2.71 ml min(-1) 1.73 m(-2) year(-1), p = 0.024) and highest quartiles (-2.78 ml min(-1) 1.73 m(-2) year(-1), p = 0.046).
CONCLUSIONS/INTERPRETATION: Lower haemoglobin concentrations in type 2 diabetic patients without clinical albuminuria may be a significant predictor of subsequent decline in GFR.
目的/假设：贫血被认为是晚期糖尿病肾病后续进展的一个独立危险因素；然而，在无临床蛋白尿的患者中，血红蛋白水平与肾病进展之间的关系尚不清楚。
我们对464例2型糖尿病患者（149名女性和315名男性，年龄55±13[均值±标准差]岁）进行了这项基于医院的前瞻性队列研究，这些患者的血清肌酐<177微摩尔/升（2.00毫克/分升），尿白蛋白：肌酐比值<300毫克/克肌酐。使用肾脏疾病饮食改良研究组制定的方程估算肾小球滤过率（GFR），该方程已针对日本个体进行了重新拟合。大多数患者的血红蛋白浓度在正常范围内（144±15克/升），仅有轻度肾功能损害（GFR：74.8±14.5毫升·分钟⁻¹·1.73米⁻²），且尿白蛋白水平正常（81.5/18.5%为正常/微量白蛋白尿）。主要结局指标是通过将GFR作为时间的函数进行回归分析确定的GFR变化率。患者的平均观察期为5.0±0.9（范围：2.5至6.2）年。
单因素和多因素回归分析显示GFR变化率与基线血红蛋白浓度之间存在显著关联。在调整协变量后，血红蛋白最低四分位数组的患者GFR下降率（-3.27毫升·分钟⁻¹·1.73米⁻²·年⁻¹）显著高于第三四分位数组（-2.71毫升·分钟⁻¹·1.73米⁻²·年⁻¹，p = 0.024）和最高四分位数组（-2.78毫升·分钟⁻¹·1.73米⁻²·年⁻¹，p = 0.046）。
结论/解读：在无临床蛋白尿的2型糖尿病患者中，较低的血红蛋白浓度可能是随后GFR下降的一个重要预测指标。
