Characteristics And Prognosis Of Patients With Diabetic Nephropathy And Non-diabetic Renal Disease At Different Hemoglobin Levels

Objective: To study the relationship between clinical indexes and prognosis of patients with diabetic nephropathy(DN)and non-diabetic renal disease(NDRD)at different hemoglobin(HGB)levels.Methods: This retrospective study selected 129 diabetic patients who were pathologically diagnosed as DN(87 cases)and NDRD(42 cases)in the Department of Nephrology,Yinzhou District Second Hospital of Ningbo City from January 2009 to December 2017.The median hemoglobin was divided into two groups,high HGB group: hemoglobin concentration(>113 g/L),a total of 67 cases;low HGB group: hemoglobin concentration(<113 g/L),a total of 62 cases.Then,Patients with DN and NDRD were divided into four subgroups according to high and low HGB。(1)The number of patients with high and low HGB differed among the glomerular stages of DN,as well as among the grades of interstitial fibrosis and tubular atrophy(IFTA).(2)Comparing the differences of basic data and laboratory data between high and low HGB groups.Comparing the differences of basic data and laboratory data among the 4 subgroups.(3)Pearson correlation analysis was used to verify the correlation between HGB and various renal function indicators.(4)Endpoint event follow-up and Kaplan-Meiersurvival analysis.(5)Cox regression analysis was used to analyze the risk factors for the deterioration of patients’ condition to ESRD.Results: 1.A total of 129 patients were enrolled,87 DN patients and 42 NDRD patients,72 males and 57 females,all of whom were confirmed by renal biopsy.The age distribution ranged from 33 to 82 years,with an average of 56.13± 9.71 years.NDRD accounted for a considerable proportion,with IgA nephropathy being the most common(10.85%).According to the stages of glomerular lesions in DN patients,it can be seen that most of the renal biopsy patients are in stage III,followed by stage II,stage IV and stage I;According to IFTA classification,most renal biopsy patients were in grade I,followed by grade II and III;Moreover,the distribution of the number of patients with high and low HGB differed between the glomerular stages(P < 0.05),as well as between the IFTA grades(P < 0.05).2.There were significant differences in age,gender,Hb A1 c,BMI,ALB,24 h urinary protein,BUN,eGFR,Scr and SBP between the high and low HGB groups(P < 0.05).There were differences in age,sex,Hb A1 c,ALB,eGFR,Scr,BUN,24 h urinary protein and SBP between the four subgroups(P < 0.05).3.Pearson correlation analysis showed that there was a correlation between HGB and renal damage index in DN and NDRD patients(P < 0.05).4.Endpoint event follow-up and Kaplan-Meier survival analysis showed that as of 30 June 2019,the mean follow-up time was 30.66± 29.50 months.Sixty-seven end-point events were observed,10 in NDRD and 57 in DN.The renal survival rate of DN patients was significantly lower than that of NDRD patients(P < 0.05).The renal survival rate of patients in the low HGB group was significantly lower than that in the high HGB group(P < 0.05).At the end of follow-up,there was a significant difference in renal survival among the four subgroups(P < 0.05).KM survival curves showed that patients with DN and low HGB had poor prognosis.5.Cox regression analysis showed that decreased eGFR,presence of KW nodules,diagnosis of DN,HGB concentration <113g/L were independent risk factors for progression to ESRD in DM patients with renal pathological changes.Conclusion: 1.Patients with DN and low HGB have severe clinicopathological damage.2.Low HGB,diagnosis of DN,presence of KW nodules,and decreased eGFR are independent risk factors for ESRD,and patients with DN combined with low HGB have poor prognosis.