Anemia modifies the prognostic value of glycated hemoglobin in patients with diabetic chronic kidney disease

A common complication of chronic kidney disease (CKD), anemia can influence glycated hemoglobin (HbA1c) levels. In diabetic patients, anemia occurs earlier and with higher severity over the course of CKD stages. To elucidate the effect of hemoglobin (Hb) on the predictive value of HbA1c, we enrolled 1558 diabetic patients with stages 3–4 CKD, categorized according to baseline Hb and HbA1c quartiles. Linear regression revealed that higher HbA1c correlated significantly with higher Hb in the Hb P = 0.004). A fully-adjusted Cox regression model revealed worse clinical outcomes in patients with higher HbA1c quartiles in the Hb ≥ 10 g/dL group. Hazard ratios for end-stage renal disease (ESRD), all-cause mortality, and composite endpoint (cardiovascular events and all-cause mortality) in patients with Hb ≥ 10 g/dL and the highest HbA1c quartile were 1.92 (95% confidence interval [CI], 1.17–3.15), 1.76 (95% CI, 1.02–3.03), and 1.54 (95% CI, 1.03–2.31), respectively. By contrast, HbA1c was not associated with clinical outcomes in the Hb贫血是慢性肾脏病（CKD）的常见并发症，可对糖化血红蛋白（HbA1c）水平产生影响。在糖尿病患者中，随着慢性肾脏病（CKD）分期进展，贫血的发生更早且严重程度更高。为阐明血红蛋白（Hb）对糖化血红蛋白（HbA1c）预测价值的影响，我们纳入了1558例处于CKD 3~4期的糖尿病患者，并根据基线血红蛋白（Hb）与糖化血红蛋白（HbA1c）的四分位数进行分组。线性回归分析显示，更高的糖化血红蛋白（HbA1c）水平与更高的血红蛋白（Hb）水平显著相关（P=0.004）。经完全校正的Cox比例风险回归模型结果显示，在血红蛋白≥10 g/dL的亚组中，糖化血红蛋白（HbA1c）四分位数更高的患者临床结局更差。该亚组中，糖化血红蛋白（HbA1c）最高四分位数患者的终末期肾病（ESRD）、全因死亡率以及复合终点（心血管事件与全因死亡率）的风险比分别为1.92（95%置信区间[CI]：1.17~3.15）、1.76（95%置信区间[CI]：1.02~3.03）与1.54（95%置信区间[CI]：1.03~2.31）。与之相反，在血红蛋白