Low erythropoietin levels predict faster renal function decline in diabetic patients with anemia: a prospective cohort study

Fujita, Yohei; Doi, Yohei; Hamano, Takayuki et al.

Scientific Reports, 2019, 9(1), 14871

Number of Access:828（2025-09-12 08:37 Counts）

Identifier to cite or link to this item: https://hdl.handle.net/11094/92484

Link to primary information 

File Format Terms of use Size Views Date.Available Description information
SciRep_9_1_14871 pdf None 1.15 MB 54 2023.09.04  
Creative Commons : Attribution

Item Information

Output File Export EndNote Basic Export Mendeley

Title
Low erythropoietin levels predict faster renal function decline in diabetic patients with anemia: a prospective cohort study
Creator
CreatorName
Fujita, Yohei
NRID
1000030846382 1000030846382
ORCID
0000-0002-5165-291X 0000-0002-5165-291X
researchmap permalink
DOI-YOHEI DOI-YOHEI
CreatorName
Doi, Yohei
CreatorName
Hamano, Takayuki
CreatorName
Hatazaki, Masahiro
CreatorName
Umayahara, Yutaka
NRID
1000000379166 1000000379166
researchmap permalink
isaka-handai3857 isaka-handai3857
Scopus Author ID
16207611100 16207611100
ORCID
0000-0002-0820-7167 0000-0002-0820-7167
CreatorName
Isaka, Yoshitaka
NRID
1000010638026 1000010638026
CreatorName
Tsubakihara, Yoshiharu
Description
Fujita Y., Doi Y., Hamano T., et al. Low erythropoietin levels predict faster renal function decline in diabetic patients with anemia: a prospective cohort study. Scientific Reports 9, 14871 (2019); https://doi.org/10.1038/s41598-019-51207-8.
Abstract
Elevated erythropoietin (EPO) levels have been reported to predict poor survival in various populations including diabetic patients. However, data regarding its impact on renal outcomes are scarce. We conducted a single-center, prospective cohort study of 339 type 2 diabetic patients with anemia. The primary outcome was the estimated glomerular filtration rate (eGFR) slope for two years. We performed multiple linear regression and restricted cubic spline analyses to assess the association of serum EPO levels with the renal outcome. Chronic kidney disease (CKD) was defined as eGFR <60 mL/min/1.73 m2 or urine albumin-to-creatinine ratio >30 mg/g creatinine. Median baseline EPO and eGFR level were 14.4 IU/L and 53 mL/min/1.73 m2, respectively. Inappropriately low EPO levels were observed in 73% of anemic patients and 59% of anemic patients even without CKD, suggesting that EPO deficiency precedes the onset of CKD in diabetes mellitus. Multivariable analysis revealed that iron status and hemoglobin levels were major determinants of EPO levels. Median eGFR slope was −1.3 mL/min/1.73 m2/year. We found that low EPO levels, but not low hemoglobin levels, were associated with a faster decline in eGFR, independent of clinically relevant factors. The eGFR decline was steeper, particularly when the EPO level was below the upper limit of normal. Lower EPO concentrations were associated with rapid eGFR decline, especially in patients with iron deficiency (P for interaction = 0.01). Relative EPO deficiency should be considered as a culprit in anemia of unknown etiology in diabetic patients, even those without CKD. Low EPO levels, especially when accompanied by poor iron status, are predictive of rapid loss of renal function.
Publisher
Nature Publishing GroupHoundmillsBasingstoke, HampshireRG21 6XS
Source Title
Scientific Reports
Volume (Issue)
9(1)
Page
14871
Date of Issued
2019-10-16
Language
English
Handle URL
https://hdl.handle.net/11094/92484
eISSN
20452322
Relation.isIdenticalTo
DOI (Publisher Version)
https://doi.org/10.1038/s41598-019-51207-8
Access Rights
open access
CopyRight
This article is licensed under a Creative Commons Attribution 4.0 International License.
oaire:version
Version of Record
Category
学術雑誌論文 Journal Article