Wang Wenjun, Wang Yetong, Tang Fangli, Liu Huanhuan, Lee Yaujiunn, Andrikopoulos Sofianos, Lou Qingqing
The First Affiliated Hospital of Hainan Medical University, Hainan Clinical Research Center for Metabolic Disease, Haikou, 570102, Hainan, China.
School of Nursing, Henan University of Science and Technology, Luoyang, 471023, Henan, China.
Diabetes Metab. 2024 Nov;50(6):101580. doi: 10.1016/j.diabet.2024.101580. Epub 2024 Sep 18.
To investigate the association between hemoglobin (Hb) levels and incident diabetic kidney disease (DKD) in patients with type 2 diabetes.
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.
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.
Lower Hb is associated with incident DKD, even in patients with normal Hb levels, independent of other risk factors.
探讨2型糖尿病患者血红蛋白（Hb）水平与糖尿病肾病（DKD）发病之间的关联。
这项回顾性队列研究纳入了1657例糖尿病患者，这些患者在基线时无糖尿病肾病，来自台湾李氏联合诊所附属的6家诊所。收集并分析了人口统计学数据和实验室检查结果。参与者根据其基线Hb水平分为四分位数。对Hb水平正常的患者（男性：Hb≥120g/L，女性：Hb≥110g/L）进行了专门的亚组分析。Cox回归分析评估了Hb水平与DKD发病之间的关系，并对相关协变量进行了调整。
在初始队列中，93例（5.6%）患者在基线时患有贫血。在平均5.7±2.6年的随访期内，594例患者（35.8%）发生了糖尿病肾病。Cox回归分析显示，在调整多个变量后，与基线Hb水平最高四分位数的患者（Q4：Hb≥154g/L）相比，最低四分位数（Q1：Hb≤130g/L）的患者发生糖尿病肾病的风险高1.6倍，风险比[95%置信区间]为1.58[1.19；2.21]，P<0.001。在Hb水平正常的患者中，Cox回归分析还显示，与最高四分位数（Q'4，Hb≥154g/L）相比，最低四分位数（Q'1，Hb≤（此处原文有误，应为≤132g/L）132g/L）的患者发生糖尿病肾病的风险高1.3倍，风险比[95%置信区间]为1.29[1.08；1.72]，P=0.042。
较低的Hb水平与糖尿病肾病发病相关，即使在Hb水平正常的患者中也是如此，且独立于其他危险因素。
