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Anemia combined with albuminuria increases the risk of cardiovascular and renal events, regardless of a reduced glomerular filtration rate, in patients with type 2 diabetes: a prospective observational study

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Abstract

Aim

The incidence of cardiovascular and renal events was investigated in patients with type 2 diabetes who were classified according to anemia and the components of dialysis-independent chronic kidney disease (CKD) in a prospective observational study.

Methods

A population of 778 Japanese patients with type 2 diabetes was prospectively analyzed for 4 years. The outcomes were the incidence of cardiovascular events and renal events.

Results

In all subjects, the incidence of cardiovascular and renal events was found to be 5% and 11%, respectively. Even after adjusting for a reduced estimated glomerular filtration rate (eGFR <60 mL/min/1.73 m2), the incidence of cardiovascular events was significantly higher (hazard ratio [HR]: 5.73) in patients with anemia and albuminuria than in those without anemia and albuminuria. The incidence of renal events was significantly higher in patients with no anemia and albuminuria (HR: 2.93) and further in those with anemia and albuminuria (HR: 7.56) than in those without anemia and albuminuria even after adjusting for a reduced eGFR.

Conclusion

Anemia combined with albuminuria is a risk factor for vascular events in patients with type 2 diabetes, regardless of the eGFR.

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Acknowledgements

The authors thank Tomoko Koyanagi in the secretarial section of Edogawa Hospital for her valuable help with data collection.

Funding

The authors received no financial support for this study.

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Authors and Affiliations

  1. Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, 2-24-18, Higashikoiwa, Edogawa-ku, Tokyo, 133-0052, Japan

    Hiroyuki Ito, Suzuko Matsumoto, Hideyuki Inoue, Takuma Izutsu, Eiji Kusano, Shinichi Antoku, Tomoko Yamasaki, Toshiko Mori & Michiko Togane

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  1. Hiroyuki Ito
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  2. Suzuko Matsumoto
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  3. Hideyuki Inoue
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  4. Takuma Izutsu
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  6. Shinichi Antoku
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  7. Tomoko Yamasaki
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  8. Toshiko Mori
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Contributions

HI contributed to the conception, design, analysis, interpretation, writing first draft, editing, and final approval. SM contributed to reviewing drafts, editing, and final approval. HI, TI, EK, SA, TY, TM, and MT contributed to data collection and final approval. All of the authors are in agreement with the content of the manuscript and have approved this submission.

Corresponding author

Correspondence to Hiroyuki Ito.

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Conflict of interest

H Ito has received lecture fees from Eli Lilly Japan KK, Novo Nordisk Pharma Ltd., Sumitomo Pharma Co., Ltd. and Boehringer Ingelheim. S Matsumoto, H Inoue, T Izutsu, E Kusano, S Antoku, T Yamasaki, T Mori, and M Togane have no conflicts of interest.

Ethical approval

The study was conducted in accordance with the principles expressed in the 2008 Declaration of Helsinki. The Ethics Committee of Edogawa Hospital approved the study protocol (approved numbers: 2015-18 and 2022-1, approved date: July 6, 2015 and November 24, 2021, respectively) and waived the need for written informed consent because the data were analyzed anonymously for this analysis based on information stored in the hospital. The trial is retrospectively registered on UMIN-CTR, identifier UMIN000047632 (1 May, 2022).

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Supplementary Information

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13340_2023_637_MOESM1_ESM.pptx

Supplementary file1 (PPTX 115 KB) Supplementary Fig. 1. Kaplan-Meier analyses of the components of cardiovascular events in the groups with and without anemia. (A) Cardiovascular death, (B) nonfatal myocardial infarction, (C) heart failure, and (D) nonfatal stroke. Supplementary Fig. S2. Kaplan-Meier analyses of the components of renal events in the groups with and without anemia. (A) End-stage kidney disease, (B) decline in eGFR by ≥30%. Supplementary Fig. S3. Kaplan-Meier analyses of the components of cardiovascular events in the groups with anemia with a hemoglobin level of <110 g/L, with anemia with a hemoglobin level of ≥110 g/L, and without anemia. Supplementary Fig. S4. Kaplan-Meier analyses of the components of renal events in the groups with anemia with a hemoglobin level of <110 g/L and anemia with a hemoglobin level of ≥110 g/L and without anemia. Supplementary Fig. S5. Kaplan-Meier analyses of cardiovascular events in the groups classified by anemia and uACR with (A) and without (B) a reduced eGFR. Supplementary Fig. S5. Kaplan-Meier analyses of renal events in the groups classified by anemia and uACR with (A) and without (B) a reduced eGFR

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Ito, H., Matsumoto, S., Inoue, H. et al. Anemia combined with albuminuria increases the risk of cardiovascular and renal events, regardless of a reduced glomerular filtration rate, in patients with type 2 diabetes: a prospective observational study. Diabetol Int 14, 344–355 (2023). https://doi.org/10.1007/s13340-023-00637-x

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