Published online Nov 15, 2021. doi: 10.4239/wjd.v12.i11.1917
Peer-review started: February 5, 2021
First decision: March 30, 2021
Revised: April 18, 2021
Accepted: October 11, 2021
Article in press: October 11, 2021
Published online: November 15, 2021
Anaemia is common in patients with chronic kidney disease (CKD) and is a major risk factor that contributes to mortality in such patients. Type 2 diabetes mellitus (T2DM) is one of the leading causes of CKD. The association between admission hemoglobin levels and renal damage in patients with T2DM remains unclear.
To evaluate the relationship between admission hemoglobin levels and prognosis in patients with T2DM.
We performed a retrospective analysis of 265 consecutive patients presenting with T2DM between 2011 and 2015. The composite endpoint was end-stage renal disease or a 50% reduction in the estimated glomerular filtration rate.
In multivariable-adjusted Cox proportional hazards models (adjusting for demographic factors, traditional risk factors, lipids), the adjusted hazard ratios (HRs) for the highest and middle tertiles compared to the lowest tertile of hemoglobin were 0.82 (95%CI: 0.11-6.26, P = 0.8457) and 0.28 (95%CI: 0.09-0.85, P = 0.0246), respectively. However, after further adjustment for glycaemia control, hemoglobin was positively related to the risk of the composite endpoint (HR: 1.05, 95%CI: 0.14-8.09, P = 0.9602) when the highest tertile was compared to the lowest tertile of hemoglobin. We found a U-shaped relationship between hemoglobin levels and the composite endpoint. The curve tended to reach the lowest level at an optimal hemoglobin level.
Among patients with T2DM, a U-shaped relationship was observed between hemoglobin levels and renal damage. A lower admission hemoglobin level (hemoglobin < 13.3 g/dL) is an independent predictor of renal damage.
Core Tip: A U-shaped exposure-response relationship exists between admission hemoglobin levels and the composite endpoint among patients with type 2 diabetes mellitus. A lower admission hemoglobin level (hemoglobin < 13.3 g/dL) is an independent predictor of renal damage. Hemoglobin is a convenient and feasible way to identify those patients who are at high risk of having a poor prognosis.