Chen Xiaojie, Xie Jianteng, Zhang Yifan, Zhang Shaogui, Li Sheng, Lu Min, Liu Danfeng, He Weiting, Yau Hokhim, Jia Runli, Zhu Yaxi, Wang Wenjian
Department of Nephrology, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, People's Republic of China.
Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangdong, People's Republic of China.
Diabetes Metab Syndr Obes. 2024 Mar 21;17:1367-1381. doi: 10.2147/DMSO.S452280. eCollection 2024.
Diabetic kidney disease (DKD) patients with anemia face an elevated risk of glomerular filtration rate decline. However, the association between hemoglobin and estimated Glomerular Filtration Rate (eGFR) progression remains to be elucidated.
A retrospective cohort of 815 subjects with DKD was followed from January 2010 to January 2023. A Cox proportional hazard regression model was utilized to explore the predictive role of hemoglobin in renal outcomes. Renal outcomes were defined as a composite endpoint, including a 50% decline in eGFR from baseline or progression to End-Stage Renal Disease (ESRD). To unveil any nonlinear relationship between hemoglobin and renal outcomes, Cox proportional hazard regression with cubic spline functions and smooth curve fitting was conducted. Additionally, subgroup analyses were performed to identify specific patient populations that might derive greater benefits from higher hemoglobin.
Among the 815 DKD subjects, the mean age was 56.482 ± 9.924 years old, and 533 (65.4%) were male. The mean hemoglobin was 121.521±22.960 g/L. The median follow-up time was 21.103±18.335 months. A total of 182 (22.33%) individuals reached the renal composite endpoint during the study period. After adjusting for covariates, hemoglobin was found to exert a negative impact on the renal composite endpoint in patients with DKD (HR 0.975, 95% CI [0.966, 0.984]). A nonlinear relationship between hemoglobin and the renal composite endpoint was identified with an inflection point at 109 g/L. Subgroup analysis unveiled a more pronounced association between hemoglobin and renal prognosis in males.
Hemoglobin emerges as a predictive indicator for the renal prognosis of diabetic kidney disease in China. This study reveals a negative and non-linear relationship between hemoglobin levels and the renal composite endpoint. A substantial association is noted when hemoglobin surpasses 109 g/L in relation to the renal composite endpoint.
患有贫血的糖尿病肾病（DKD）患者肾小球滤过率下降的风险升高。然而，血红蛋白与估计肾小球滤过率（eGFR）进展之间的关联仍有待阐明。
对815例DKD患者进行回顾性队列研究，随访时间从2010年1月至2023年1月。采用Cox比例风险回归模型探讨血红蛋白对肾脏结局的预测作用。肾脏结局定义为一个复合终点，包括eGFR较基线下降50%或进展至终末期肾病（ESRD）。为揭示血红蛋白与肾脏结局之间的任何非线性关系，进行了带有三次样条函数和光滑曲线拟合的Cox比例风险回归分析。此外，进行亚组分析以确定可能从较高血红蛋白水平中获得更大益处的特定患者群体。
在815例DKD患者中，平均年龄为56.482±9.924岁，533例（65.4%）为男性。平均血红蛋白为121.521±22.960 g/L。中位随访时间为21.103±18.335个月。在研究期间，共有182例（22.33%）个体达到肾脏复合终点。在调整协变量后，发现血红蛋白对DKD患者的肾脏复合终点有负面影响（HR 0.975，95% CI [0.966, 0.984]）。确定了血红蛋白与肾脏复合终点之间的非线性关系，拐点为109 g/L。亚组分析显示男性中血红蛋白与肾脏预后的关联更为明显。
血红蛋白是中国糖尿病肾病肾脏预后的一个预测指标。本研究揭示了血红蛋白水平与肾脏复合终点之间的负向非线性关系。当血红蛋白超过109 g/L时，与肾脏复合终点存在显著关联。
