ORIGINAL ARTICLE Hospitalization and 1-year all-cause mortality in type 2 diabetic patients with chronic kidney disease at Stages 1 and 2: Effect of mild anemia William NSEIR, 1,2 Suheil ARTUL, 2,3 Najib NASRALLAH, 3 Julnar MOGRABI 1 and Mahmud MAHAMID 1,2 1 Intenal Medicine Department, Holy Family Hospital, 3 Division of Internal Medicine, EMMS, The Nazareth Hospital, Nazareth, and 2 Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel Correspondence William Nseir, The Nazareth Hospital EMMS, Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, P.O.B. 11, 16100, Israel. Tel: +972 74 755 9050 Fax: +972 74 755 9051 Email: w.nseir@yahoo.com Received 24 March 2015; revised 8 May 2015; accepted 31 May 2015. doi: 10.1111/1753-0407.12318 Abstract Background: The effect of anemia in advanced chronic kidney disease (CKD) on morbidity and mortality is known. The aim of the present study was to assess the effect of mild anemia on hospitalization and 1-year all-cause mortality in type 2 diabetes mellitus (T2DM) patients with Stage 1 and 2 CKD. Methods: Hospitalized T2DM patients (n = 307) with a glomerular filtration rate ≥ 60 mL/min per 1.73 m 2 and urinary albumin excretion > 30 mg/24 h (Stage 1 and 2 CKD) were enrolled in the study and divided into two groups based on hemoglobin (Hb) concentrations: those with (mean [ ± SD] Hb 10.7 ± 0.7 g/dL) and without (mean Hb 13.3 ± 1.28 g/dL) anemia. Results: There was no significant difference between patients with and without anemia in terms of age, gender, body mass index, HbA1c, and car- diovascular diseases. The mean length of hospitalization of the 130 anemic and 177 non-anemic patients was 4.3 ± 3.5 and 3.5 ± 1.9 days, respectively (P < 0.001). Twelve anemic patients died within 1 year, compared with three patients without anemia (9.2% vs 1.7%, respectively; P = 0.002). After adjust- ing for confounding variables, multivariate Cox regression analysis revealed that mild anemia was significantly associated with 1-year all-cause mortality (hazard ratio 2.15, 95% confidence interval 1.92–2.54; P = 0.033). Conclusions: Mild anemia may increase the length of hospitalization and was associated with 1-year all-cause mortality among hospitalized T2DM patients with Stage 1 and 2 CKD. Keywords: 1-year all-cause mortality, anemia, diabetes mellitus, length of hospitalization, stage 1 and 2 CKD. Introduction Anemia is a common condition in the older population, and the prevalence of anemia rises with advancing age. 1,2 However, anemia is a common and frequently unrecog- nized complication of diabetes and its prevalence varies according to the severity of renal failure, study population, and criteria for the definition of anemia, 3,4 having been reported to be in the range 8%–23%. 3–6 A previous study showed that the prevalence of anemia in Significant findings of the study: Mild anemia in hospitalized T2DM patients with Stage 1 and 2 CKD is not an uncommon finding, it may increase the length of hospitalization, and is associated with 1-year all-cause mortality. What this study adds: This study provides new evidence of the effect of mild anemia in T2DM patients with Stage 1 and 2 CKD. Journal of Diabetes 8 (2016), 02– 0 5 5 7 © 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley Sons Australia, Ltd & 502