title: Lower haemoglobin level and subsequent decline in kidney function in type 2 diabetic adults without clinical albuminuria.
abstract: OBJECTIVE
  Anaemia has been suggested to be an independent risk factor for subsequent progression of advanced diabetic nephropathy; however, the relationship between haemoglobin levels and progression of nephropathy in patients without clinical albuminuria is unknown.
  
  
  METHODS
  We conducted this prospective hospital-based cohort study of 464 type 2 diabetic patients (149 women and 315 men, 55+/-13 [mean+/-SD] years of age) with serum creatinine <177 micromol/l (2.00 mg/dl) and urinary albumin : creatinine ratio <300 mg/g creatinine. GFR was estimated using the equation formulated by the Modification of Diet in Renal Disease Study group, refitted for Japanese individuals. Most patients had haemoglobin concentrations in the normal range (144+/-15 g/l), only modest renal impairment (GFR: 74.8+/-14.5 ml min(-1) 1.73 m(-2)), and normal urinary albumin levels (81.5/18.5% with normo-/microalbuminuria). The primary outcome measurement was the rate of change in GFR determined by regression analysis with GFR as a function of time. Patients were followed up for a mean observation period of 5.0+/-0.9 (range: 2.5 to 6.2) years.
  
  
  RESULTS
  Univariate and multiple regression analyses yielded a significant association between the rate of change in GFR and baseline haemoglobin concentration. After adjusting for covariates, the rate of decline in GFR was significantly greater in patients in the lowest haemoglobin quartile (-3.27 ml min(-1) 1.73 m(-2) year(-1)) than in the third (-2.71 ml min(-1) 1.73 m(-2) year(-1), p = 0.024) and highest quartiles (-2.78 ml min(-1) 1.73 m(-2) year(-1), p = 0.046).
  
  
  CONCLUSIONS
  Lower haemoglobin concentrations in type 2 diabetic patients without clinical albuminuria may be a significant predictor of subsequent decline in GFR.
authors.affiliation: Division of Nephrology and Hypertension, Diabetes Centre, Tokyo Women's Medical University School of Medicine, 8-1 Kawadacho, Shinjukuku, Tokyo, 162-8666, Japan. babazono@dmc.twmu.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Babazono
authors.forename: K
authors.initials: K
authors.lastname: Hanai
authors.forename: K
authors.initials: K
authors.lastname: Suzuki
authors.forename: Y
authors.initials: Y
authors.lastname: Kiuchi
authors.forename: A
authors.initials: A
authors.lastname: Inoue
authors.forename: M
authors.initials: M
authors.lastname: Tanaka
authors.forename: N
authors.initials: N
authors.lastname: Tanaka
authors.forename: M
authors.initials: M
authors.lastname: Hase
authors.forename: A
authors.initials: A
authors.lastname: Ishii
authors.forename: Y
authors.initials: Y
authors.lastname: Iwamoto
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria; D001794:Blood Pressure; D015992:Body Mass Index; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control; D005260:Female; D006453:Hemoglobinopathies / Q000503:physiopathology; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged
chemical_list: D006454:Hemoglobins; D003404:Creatinine