Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Nov 15, 2021; 12(11): 1917-1927
Published online Nov 15, 2021. doi: 10.4239/wjd.v12.i11.1917
Association between admission hemoglobin level and prognosis in patients with type 2 diabetes mellitus
Hai-Ying Song, Cui-Mei Wei, Wen-Xiong Zhou, Hao-Fei Hu, Qi-Jun Wan
Hai-Ying Song, Cui-Mei Wei, Wen-Xiong Zhou, Hao-Fei Hu, Qi-Jun Wan, Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, Guangdong Province, China
Hai-Ying Song, Cui-Mei Wei, Wen-Xiong Zhou, Hao-Fei Hu, Qi-Jun Wan, Department of Nephrology, Shenzhen University Health Science Center, Shenzhen 518035, Guangdong Province, China
Author contributions: Song HY, Hu HF, and Wan QJ contributed to the study concept and design, acquired and interpreted the data, and drafted the manuscript, and they are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis; Wei CM and Zhou WX cross-checked the data and reviewed the manuscript; Wei CM oversaw the progress of the project and contributed to the discussion; all authors read and approved the final manuscript.
Supported by the Research Project of Health and Family Planning Commission of Shenzhen Municipality, No. SZFZ2018063; Shenzhen Key Medical Discipline Construction Fund, No. SZXK009; Sanming Project of Medicine in Shenzhen, No. SZSM201512004; and Shenzhen Second People’s Hospital Clinical Research Fund of Guangdong Province High-level Hospital Construction Project, No. 20203357003 and No. 20213357018.
Institutional review board statement: The proposal was approved by the Clinical Research Ethical Committee of the Shenzhen Second People’s Hospital, and all subjects provided informed consent before enrollment. We adhered to the principles of the Declaration of Helsinki. The procedures followed were in accordance with institutional guidelines.
Informed consent statement: Informed consent statement was waived.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi-Jun Wan, PhD, Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, No. 3002 Sungang West Road, Futian District, Shenzhen 518035, Guangdong Province, China. yiyuan2224@sina.com
Received: February 5, 2021
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
Abstract
BACKGROUND

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.

AIM

To evaluate the relationship between admission hemoglobin levels and prognosis in patients with T2DM.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: Type 2 diabetes mellitus, Hemoglobin, Renal damage, Prognosis

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.