title: Association of hypoalbuminemia with severe anemia in patients with diabetic nephrosclerosis.
abstract: BACKGROUND
  Anemia in patients with early diabetes mellitus nephrosclerosis (DMN) is more severe than in patients with kidney disease of other origins, and the mechanism for this remains unclear. In this study, we carried out a retrospective study in order to identify the factors associated with anemia in patients with DMN.
  
  
  METHODS
  To elucidate the factors that influence the severity of anemia in patients with DMN, we carried out a retrospective follow-up study of 124 biopsy-proven DMN cases [mean (SE) age, 55.3 (1.2) years; range, 18-78 years; male/female, 80/44]. First, a cluster analysis was performed using red blood cell counts and hemoglobin (Hb) and hematocrit levels. We then divided the clusters with regard to renal prognosis and survival and carried out simple and multifactorial analysis of clinical data, including the body mass index, age, systolic blood pressure (BP), diastolic BP, duration after the diagnosis of diabetes mellitus, serum albumin levels, blood urea nitrogen (BUN) concentrations, serum creatinine concentrations, the estimated glomerular filtration rate (eGFR) validated in the Japanese population, iron levels, total cholesterol levels, triglyceride levels, fasting blood sugar levels, HbA1c levels, urinary protein secretion, and pathohistological parameters.
  
  
  RESULTS
  The factors that were significantly associated with the cluster group that showed severe anemia were sex (p = 0.0162), hypoalbuminemia (p < 0.0001), high BUN concentrations (p = 0.0020), low eGFR (p = 0.0104), and Kimmelstiel-Wilson nodules (p = 0.0022). In addition, hypoalbuminemia (p = 0.0277), high BUN concentrations (p = 0.0338), and a low eGFR (p = 0.0417) were significantly associated with this group in a multifactorial analysis.
  
  
  CONCLUSIONS
  Our data strongly suggest that hypoalbuminemia is associated with severe anemia in DMN patients.
authors.affiliation: Division of Nephrology & Rheumatology, Department of Internal Medicine, Fukuoka University School of Medicine, Fukuoka, Japan. sasatomi@fukuoka-u.ac.jp
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Sasatomi
authors.forename: Kenji
authors.initials: K
authors.lastname: Ito
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Abe
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Miyake
authors.forename: Satoru
authors.initials: S
authors.lastname: Ogahara
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nakashima
authors.forename: Takao
authors.initials: T
authors.lastname: Saito
mesh_terms: D000740:Anemia / Q000209:etiology*; D003928:Diabetic Nephropathies / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D034141:Hypoalbuminemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009400:Nephrosclerosis / Q000150:complications*; D012189:Retrospective Studies; D012720:Severity of Illness Index