title: Hematocrit, independent of chronic kidney disease, predicts adverse cardiovascular outcomes in chinese patients with type 2 diabetes.
abstract: OBJECTIVE
  Anemia and chronic kidney disease (CKD) are risk factors for cardiovascular diseases in diabetes. We examined the association between hematocrit, stratified by the presence of CKD, and cardiovascular events in a cohort of Chinese subjects with type 2 diabetes.
  
  
  METHODS
  A total of 3,983 patients who underwent assessment for diabetes complications were recruited. Subjects were categorized into five groups. Group I included subjects with hematocrit below the normal sex-specific range. The cutoff points for groups II-V were selected to represent the distribution of the hematocrit for each sex. CKD was defined by the estimated glomerular filtration rate <60 ml/min per 1.73 m(2). Cardiovascular events were defined as cardiovascular mortality and morbidity, including new onset of myocardial infarction, acute coronary syndrome, revascularization, heart failure, and stroke requiring hospitalization.
  
  
  RESULTS
  A total of 294 subjects (7.4%) developed cardiovascular events during the median of 36.4 months. The rate of cardiovascular events was highest in subjects with low hematocrit (group I, 18.6%) compared with group V (3.4%, P < 0.001). The multivariate-adjusted hazard ratio for cardiovascular events diminished with increasing hematocrit (group I, 1.0; group II, 0.73 [95% CI 0.51-1.04]; group III, 0.57 [0.39-0.83]; group IV, 0.61 [0.39-0.95]; and group V, 0.36 [0.17-0.79]). After stratifying by the presence of CKD, the previously observed reduction in the risk of developing cardiovascular events with increasing hematocrit was abolished in the cohort with CKD but persisted in the non-CKD cohort.
  
  
  CONCLUSIONS
  In Chinese subjects with type 2 diabetes, low levels of hematocrit and the presence of CKD are associated with increased risk of developing adverse cardiovascular events.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong. ptong@cuhk.edu.hk
authors.forename: Peter C Y
authors.initials: PC
authors.lastname: Tong
authors.forename: Alice P S
authors.initials: AP
authors.lastname: Kong
authors.forename: Wing-Yee
authors.initials: WY
authors.lastname: So
authors.forename: Margaret H L
authors.initials: MH
authors.lastname: Ng
authors.forename: Xilin
authors.initials: X
authors.lastname: Yang
authors.forename: Maggie C Y
authors.initials: MC
authors.lastname: Ng
authors.forename: Ronald C W
authors.initials: RC
authors.lastname: Ma
authors.forename: Chung-Shun
authors.initials: CS
authors.lastname: Ho
authors.forename: Christopher W K
authors.initials: CW
authors.lastname: Lam
authors.forename: Chun-Chung
authors.initials: CC
authors.lastname: Chow
authors.forename: Clive S
authors.initials: CS
authors.lastname: Cockram
authors.forename: Juliana C N
authors.initials: JC
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D003925:Diabetic Angiopathies / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D003928:Diabetic Nephropathies / Q000097:blood / Q000175:diagnosis / Q000208:ethnology*; D005260:Female; D005500:Follow-Up Studies; D006400:Hematocrit; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors