Combined residual inflammation and anemia in relation to kidney function among adults with diabetes: a CHARLS-based cross-sectional and longitudinal study
4 affiliations
- 1Medical College, Binzhou Polytechnic University, Binzhou, Shandong 256600 China
- 2Department of Nephrology, The Third Hospital of Jilin University, Changchun, Jilin 130033 China
- 3Department of Nephrology, Binzhou People’s Hospital Affiliated to Shandong First Medical University, Binzhou, Shandong 256610 China
- 4Health College, Binzhou Polytechnic University, No. 919, Huanghe 12th Road, Binzhou, Shandong 256600 China
Abstract
Background: The combined phenotype of residual inflammation and anemia on kidney function in diabetes remains unclear. Our study examined their joint association with impaired kidney function and kidney function decline in a nationally representative Chinese sample.
Methods: Our study encompassed 2,363 diabetes patients from the China Health and Retirement Longitudinal Study (CHARLS) for cross-sectional analysis and a sub-cohort of 547 patients for longitudinal analysis (2011–2015). Exposures comprised residual inflammation (hs-CRP ≥ 2.0 mg/L) and WHO-defined anemia. Outcomes were prevalent impaired kidney function in the cross-sectional analysis and rapid kidney function decline (RKFD) in the longitudinal analysis. Logistic and linear regression, restricted cubic splines, and subgroup and sensitivity analyses were applied.
Results: Cross-sectionally, isolated residual inflammation or isolated anemia were each associated with impaired kidney function, while the combined phenotype showed the strongest association (OR = 3.61, 95% CI: 2.16–5.99; P < 0.001). Longitudinally, this combined phenotype conferred the highest risk for RKFD (OR = 6.42, 95% CI: 2.18–18.34; P < 0.001) and was the only group associated with a steeper eGFR decline (β=-8.68 mL/min/1.73 m², 95% CI: -15.72 to -1.64; P = 0.011). Sensitivity analyses and RCS models supported the robustness of these associations.
Conclusion: Coexisting residual inflammation and anemia are associated with a higher prevalence of kidney function impairment and a more rapid kidney function decline among diabetic patients. Addressing both conditions concurrently as an integrated clinical phenotype may better mitigate kidney function decline.
Clinical trial number: Not applicable.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12902-026-02577-4.
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BibTeX
@article{yang2026combined,
title = {{Combined residual inflammation and anemia in relation to kidney function among adults with diabetes: a CHARLS-based cross-sectional and longitudinal study}},
author = {Wenhao Yang and Jinkui Zhao and Mingyan Yu and Qianyu Li and Rui Li and Xihai Gao and Changyong Lin and Zihan Zhai and Xiao Huang and Bo Wu},
journal = {BMC Endocrine Disorders},
year = {2026},
month = oct,
doi = {10.1186/s12902-026-02577-4},
url = {https://doi.org/10.1186/s12902-026-02577-4},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Combined residual inflammation and anemia in relation to kidney function among adults with diabetes: a CHARLS-based cross-sectional and longitudinal study
AU - Wenhao Yang
AU - Jinkui Zhao
AU - Mingyan Yu
AU - Qianyu Li
AU - Rui Li
AU - Xihai Gao
AU - Changyong Lin
AU - Zihan Zhai
AU - Xiao Huang
AU - Bo Wu
PY - 2026
DA - 2026/10/23
JO - BMC Endocrine Disorders
DO - 10.1186/s12902-026-02577-4
UR - https://doi.org/10.1186/s12902-026-02577-4
AB - Background: The combined phenotype of residual inflammation and anemia on kidney function in diabetes remains unclear. Our study examined their joint association with impaired kidney function and kidney function decline in a nationally representative Chinese sample. Methods: Our study encompassed 2,363 diabetes patients from the China Health and Retirement Longitudinal Study (CHARLS) for cross-sectional analysis and a sub-cohort of 547 patients for longitudinal analysis (2011–2015). Exposures comprised residual inflammation (hs-CRP ≥ 2.0 mg/L) and WHO-defined anemia. Outcomes were prevalent impaired kidney function in the cross-sectional analysis and rapid kidney function decline (RKFD) in the longitudinal analysis. Logistic and linear regression, restricted cubic splines, and subgroup and sensitivity analyses were applied. Results: Cross-sectionally, isolated residual inflammation or isolated anemia were each associated with impaired kidney function, while the combined phenotype showed the strongest association (OR = 3.61, 95% CI: 2.16–5.99; P < 0.001). Longitudinally, this combined phenotype conferred the highest risk for RKFD (OR = 6.42, 95% CI: 2.18–18.34; P < 0.001) and was the only group associated with a steeper eGFR decline (β=-8.68 mL/min/1.73 m², 95% CI: -15.72 to -1.64; P = 0.011). Sensitivity analyses and RCS models supported the robustness of these associations. Conclusion: Coexisting residual inflammation and anemia are associated with a higher prevalence of kidney function impairment and a more rapid kidney function decline among diabetic patients. Addressing both conditions concurrently as an integrated clinical phenotype may better mitigate kidney function decline. Clinical trial number: Not applicable. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12902-026-02577-4.
SN - 1472-6823
ER -