INTRODUCTION Previous studies failed to adjust for estimated glomerular filtration rate (eGFR) in evaluating the association between albuminuria and anemia development, and we aimed to investigate whether albuminuria independently affects anemia development. METHODS We conducted a retrospective cohort study and retrospectively identified adults with diabetes from a Japanese nationwide clinical database (JMDC, Tokyo, Japan). To assess the modification effects of albuminuria on the association between eGFR and anemia development, we estimated prevalence of anemia, defined as hemoglobin < 13 g/dL in men and < 12 g/dL in women, using a modified Poisson regression and marginal standardization form of predictive margins, stratified by albuminuria severity after adjusting for eGFR. Hence, we revealed at which eGFR level this modification effect appeared and the extent to which this modification effect increased the prevalence of anemia. RESULTS We identified 327,999 data points from 48,056 individuals (normoalbuminuria: 186,472 [56.9%], microalbuminuria: 107,170 [32.7%], and macroalbuminuria: 34,357 [10.5%]). As eGFR declined, anemia prevalence increased. Albuminuria severity modified this association induced by decreased eGFR among individuals with eGFR <30 ml/min/1.73 m2 after adjusting for multivariable factors, including age, sex, comorbidities, and medication use. Compared with the normoalbuminuric group, the macroalbuminuric group had a 5-20% higher anemia prevalence among individuals with eGFR of <30 ml/min/1.73 m2. CONCLUSION We revealed that the severity of albuminuria modified the association between eGFR and anemia development among individuals with eGFR <30 ml/min/1.73 m2, highlighting the modification effect of albuminuria on the association between kidney function and anemia development in diabetes.

中文翻译：

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蛋白尿对肾功能与糖尿病贫血发展之间关系的改变作用。

简介 先前的研究在评估蛋白尿和贫血发展之间的关联时未能调整估计的肾小球滤过率（eGFR），我们的目的是研究蛋白尿是否独立影响贫血的发展。方法 我们进行了一项回顾性队列研究，并从日本全国临床数据库（JMDC，日本东京）中回顾性识别了患有糖尿病的成人。为了评估白蛋白尿对 eGFR 与贫血发展之间关系的修正作用，我们使用改良的泊松回归和边际标准化形式估计了贫血的患病率，贫血的患病率定义为男性血红蛋白 < 13 g/dL，女性 < 12 g/dL调整 eGFR 后根据蛋白尿严重程度进行分层的预测边界。因此，我们揭示了这种改变效应出现在什么 eGFR 水平，以及这种改变效应增加贫血患病率的程度。结果 我们从 48,056 名个体中确定了 327,999 个数据点（正常白蛋白尿：186,472 [56.9%]，微量白蛋白尿：107,170 [32.7%]，大量白蛋白尿：34,357 [10.5%]）。随着 eGFR 下降，贫血患病率增加。在调整了多变量因素（包括年龄、性别、合并症和药物使用）后，蛋白尿严重程度改变了 eGFR <30 ml/min/1.73 m2 个体中 eGFR 降低引起的这种关联。与正常白蛋白尿组相比，eGFR <30 ml/min/1.73 m2 的个体中，大量白蛋白尿组的贫血患病率高出 5-20%。结论 我们发现，在 eGFR <30 ml/min/1.73 m2 的个体中，白蛋白尿的严重程度改变了 eGFR 与贫血发生之间的关联，突出了白蛋白尿对糖尿病患者肾功能与贫血发生之间关系的改变作用。