Role of hemoglobin in the identification of diabetic nephropathy and non-diabetic renal disease

Abstract

Objective To investigate the clinical significance of hemoglobin in the differential diagnosis of diabetic nephropathy (DN) and non-diabetic renal disease (NDRD). Methods A retrospective analysis was conducted in 66 patients with DN and 78 patients with NDRD, who underwent renal biopsy and had complete medical history data in the Department of Nephrology, PLA General Hospital from January 2004 to April 2012. The differences between the two groups in clinical indicators and comorbidities were compared, and multivariate logistic regression analysis was used to identify independent risk factors for DN. The differences in hemoglobin levels were compared between the DN group and the NDRD group at different stages of chronic kidney disease (CKD) to identify the anemia characteristics and independent risk factors associated with anemia. Results The history of diabetes, history of nephropathy, mean arterial pressure, serum creatinine, urea nitrogen, 24-hour urine protein, and the proportions of diabetic retinopathy, cardiovascular disease, and anemia were higher in the DN group than in the NDRD group (P<0.05). Multivariate analysis showed the diabetes history (OR=1.012, 95%CI 1.005-1.019), diabetic retinopathy (OR=4.265, 95%CI 1.616-11.255), hemoglobin levels (OR=0.952, 95%CI 0.929-0.976), and cardiovascular disease (OR=2.875, 95%CI 1.089-7.593) were independently associated with DN. There were significant differences in hemoglobin levels at CKD stages 1-3 between the DN group and the NDRD group (P<0.05), and the differences disappeared at CKD stages 4-5. In the DN and the NDRD groups, there were altogether 60 patients with anemia which were all normocytic normochromic anemia. Multivariate logistic regression analysis showed decreased albumin (OR=0.928, 95%CI 0.879-0.980), elevated serum creatinine (OR=1.011, 95%CI 1.004-1.019), and pathologically diagnosed DN (OR= 6.213, 95%CI 2.690-14.347) were independent risk factors for anemia. Conclusion Hemoglobin was significantly and independently associated with DN. Early monitoring of hemoglobin levels may provide new clues for clinical identification of DN and NDRD. Key words: Type 2 diabetes; Diabetic nephropathy; Non-diabetic renal disease; Hemoglobin; Anemia