However, one study in Chinese patients with diabetes indicated a causal relationship between elevated circulating homocysteine levels and risk of DKD [48]; in hospitalized Han patients with T2DM, low serum Alb concentration was independently associated with diabetic retinopathy and DKD [30]; and serum albumin was identified as an important predictor of ESRD in patients with T2DM and DKD from three clinical trials (RENAAL [n = 1513], IDNT [n = 1715]and ALTITUDE [n = 8561]) using a feedforward neural network [40]. This evidence concerns the gene ALB and diabetic retinopathy.