Anaemia among primary care patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD): a multicentred cross-sectional study

Abstract

ObjectivesThis study aimed to determine the prevalence of anaemia among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) at primary care settings and its associated factors.Design, setting and participantsThis cross-sectional study involved 808 adult patients with T2DM and CKD who were recruited via systematic sampling from 20 public primary care clinics in Peninsular Malaysia. Their sociodemographic, clinical and biomedical profiles were collected through interviews, examination of medical records and blood testing.ResultsThe prevalence of anaemia was 31.7% (256/808). The anaemia was mainly mild (61.5%) and normocytic normochromic (58.7%). About 88.7% of the patients with anaemia were not known to have anaemia prior to the study. Among 36 patients with documented history of anaemia, 80.6% were still anaemic, and only a half received iron therapy. Multivariate regression analysis showed that women (adjusted odd ratio (AOR): 1.57, 95% CI: 1.12 to 2.21, p=0.009) and those with older age (AOR: 1.04, 95% CI: 1.01 to 1.06, p<0.001), CKD stage 3a (AOR: 2.47; 95% CI: 1.25 to 4.87, p=0.009), CKD stage 3b (AOR: 4.36; 95% CI: 2.14 to 8.85, p<0.001), CKD stage 4 (AOR: 10.12; 95% CI: 4.36 to 23.47, p<0.001), CKD stage 5 (AOR: 10.80; 95% CI: 3.32 to 35.11, p<0.001) and foot complication (AOR 3.12, 95% CI: 1.51 to 6.46, p=0.002) were more likely to have anaemia. Having higher body mass index (AOR 0.95, 95% CI: 0.92 to 0.99, p=0.012) and higher diastolic blood pressure (AOR 0.97, 95% CI: 0.95 to 0.99, p<0.001) were associated with lower odds to have anaemia.ConclusionAnaemia among patients with T2DM and CKD in primary care was common, and the majority was unrecognised. Inadequate treatment of anaemia was also prevalent. Therefore, screening of anaemia should be incorporated into the routine assessment of diabetic complications particularly for those with significant associated factors. It is hoped that such strategy could lead to early treatment and hence improve their overall care.Trial registration numberNMRR-15-660-24324.

<p>Anemia and Its Associated Factors Among Type 2 Diabetes Mellitus Patients Attending Debre Berhan Referral Hospital, North-East Ethiopia: A Cross-Sectional Study</p>

“…Normocytic normochromic blood picture was the most common morphological types of anemia found in this study. It is not surprising to see normocytic normochromic blood picture of anemia in this study, as various previous studies conducted in China, 57 Malaysia, 54,55 India, 58,59 and Iraq, 60 also revealed this situation. Since the participants of this study were DM patients, anemia of chronic disease is expected, which is normocytic normochromic in morphology.…”

“…24 However, this finding was relatively higher than a study conducted by Rani et al, in India (12.3%), 49 and Kuwait (13%). 50 On the other hand, this finding was relatively lower than a cross-sectional study conducted in Brazil (34.24%), 21 Kuwait (29.7%), 35 Egypt (63%), 33 United Kingdom (59%), 51 Caribbean (46.5%), 28 Iran (30.4%), 52 Pakistan (63%), 53 Malaysia (31.7-39%), 54,55 and Fenote Selam Hospital (29.8%). 32 These differences might be due to differences in the geographical elevation above sea level, ethnicity, age of the study participants, duration of DM, and the level of development of the country since it affects the quality of health care delivery.…”

“…This study is similar to the finding in Malaysia. 54,55 In this study, there was a statistically significant relation between diabetes-related complications and the occurrence of anemia. As microvascular complications were frequently seen in uncontrolled and long-standing diabetes, 53 the odds ratio of developing anemia in patients with at least one diabetic complication were approximately four times more likely as compared with those without complication.…”

Risk Factors for Anemia in Patients with Chronic Renal Failure: A Systematic Review and Meta-Analysis

“…The present study showed that CKD patients with pre-existing illnesses were nearly three times more likely to develop anemia, which mirrors results from studies in Australia (59), London (60) and Malaysia (61).This finding suggests that any CKD patient who presents with comorbidities should be more closely monitored for anemia. Approprite management of comorbid illnesses may therefore reduce the odds of developing anemia.…”

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“…The results show that damage to interstitial cells or disruption of the interaction between tubules, peritubular fibroblasts and endothelium, necessary for normal hematopoiesis, contribute to impaired erythropoietin secretion [34]. Some authors propose to consider the production of this hormone as a marker of the severity of tubulointerstitial changes in diabetes mellitus [35]. In addition to damage to tubulointerstitial cells, anemia can also be caused by disturbances in the feedback mechanisms between tissue oxygenation, erythropoietin, and hemoglobin [34].…”