Anemia and end-stage renal disease in patients with type 2 diabetes and nephropathy.
BACKGROUND
Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD). Anemia is common in diabetics with nephropathy; however, the impact of anemia on progression to ESRD has not been carefully examined.


METHODS
We studied the relationship between baseline hemoglobin concentration (Hb) and progression of diabetic nephropathy to ESRD in 1513 participants enrolled in Reduction in Endpoints in NIDDM with the Angiotensin II Antagonist Losartan study and followed for an average of 3.4 years. Multivariate Cox proportional hazards models were used to analyze the relationship between Hb and ESRD, after adjusting for predictors for ESRD. Analyses were performed with Hb stratified by quartile: first quartile <11.3 g/dL, second quartile 11.3 to 12.5 g/dL, third quartile 12.6 to 13.8 g/dL, and fourth quartile >/=13.8 g/dL (reference) and as a continuous variable.


RESULTS
Baseline hemoglobin concentration was correlated with subsequent development of ESRD. After adjustment for predictors of ESRD, the hazard ratios for the first, second, and third Hb quartiles were 1.99 (95% CI, 1.34-2.95), 1.61 (95% CI 1.08-2.41), and 1.87 (95% CI 1.25-2.80). With hemoglobin as a continuous variable, the adjusted hazard ratio was 0.90 (95% CI 0.84-0.96, P= 0.0013). The average increase in adjusted relative risk was 11% for each 1 g/dL decrease in hemoglobin concentration.


CONCLUSIONS
Our data suggest that even mild anemia, Hb <13.8 g/dL increases risk for progression to ESRD. Hemoglobin is an independent risk factor for progression of nephropathy to ESRD in type 2 diabetes.
UT Southwestern Medical Center, Dallas, Texas 75390-8856, USA.
Anupama
A
Mohanram
Zhongxin
Z
Zhang
Shahnaz
S
Shahinfar
William F
WF
Keane
Barry M
BM
Brenner
Robert D
RD
Toto
D000368:Aged; D000740:Anemia / Q000209:etiology / Q000401:mortality*; D000959:Antihypertensive Agents / Q000008:administration & dosage; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D018450:Disease Progression; D005260:Female; D006454:Hemoglobins; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D019808:Losartan / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
D000959:Antihypertensive Agents; D006454:Hemoglobins; D019808:Losartan