Association of Anemia with Cardiovascular disease in patients with Diabetic Nephropathy with normal GFR

Background: Anemia is recognized as an independent cardiovascular disease (CVD) risk factor in diabetic patients with end stage renal disease. However, it is not known whether anemia associated with early diabetic nephropathy increases CVD risk.Objective: To assess the effect of anemia on CVD risk in patients with Stage 1 chronic kidney disease (CKD).Materials and Methods: Cross sectional analysis of 2,502 diabetic patients with stage 1 CKD. Demographic, clinical and laboratory data were collected from two teaching hospitals affiliated with medical university in Lahore, Pakistan.Results: Of the 2,502 diabetic patients examined, 96% had type 2 diabetes. Age (years) = 64.2 ± 0.2, BMI= 29.6±0.2, duration of diabetes (years) = 9.3± 0.17, Hemoglobin A1C (A1C) % =7.8±0.04. Males represented 83.2% of the cohort.The CVD group included 909 (36.3%) of the total cohort and had a significantly lower mean serum hemoglobin (g/dl) (12.9±0.05 Vs 13.4±0.04, p <0.01), and hematocrit (%) (38.8±0.19 Vs 40.04±0.17, p<0.01), compared to those without CVD events. Both groups had stage I diabetic nephropathy with urinary albumin >30 mg/gm creatinine and normal GFR (>90 ml/min/1.73m2). Using the National Kidney Foundation (NKF) threshold Hb of 12 g/dl for initiation of work up for anemia in chronic kidney disease, in our logistic regression model the odds ration (OR) for CVD in patients with Hb<12 g/dl was 1.94 (95% CI= 1.6-2.3, p <0.01). After adjusting for CVD risk factors, anemia remained a significant predictor for CVD events OR=1.64 (95%CI = 1.3-2.0, p<0.01). We also examined Hb as a continuous variable and found that; for each unit decrease in hemoglobin, the odds of CVD increases, OR =1.21 (1.14-1.28, p <0.01)

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