How should we manage anaemia in patients with diabetes?

Dikow, Ralf; Schwenger, Vedat; Schömig, Michael; Ritz, Eberhard

doi:10.1093/ndt/17.suppl_1.67

Cited by 77 publications

(66 citation statements)

References 40 publications

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“…Diabetic nephropathy in patients with type 1 DM (T1DM) rarely develops earlier than 10 years after diagnosis, whereas approximately 3 % of patients with newly diagnosed type 2 DM (T2DM) already have overt nephropathy [7][8][9]. Diabetic nephropathy is the most common cause of CKD [10][11][12], and diabetic patients in some countries account for 40-50 % of patients receiving dialysis [13].…”

Section: Introductionmentioning

confidence: 99%

Less known pathophysiological mechanisms of anemia in patients with diabetic nephropathy

Παππά¹,

Dounousi

Duni

et al. 2015

Int Urol Nephrol

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Diabetes mellitus (DM) is currently considered a modern global epidemic, and diabetic nephropathy (DN) is the most common cause of chronic kidney disease (CKD). Anemia is one of the most significant complications of CKD, and it is mainly attributed to insufficient erythropoietin (EPO) production. However, anemia develops earlier in the course of CKD among patients with DM, and the severity of anemia tends to be more marked in these patients compared to nondiabetic subjects, regardless of the stage of CKD. In this review, we focus on the "less known" complex interacting mechanisms which are involved in the pathophysiology of anemia associated with DN. Although the major cause of anemia in DN is considered to be an inappropriate response of the plasma EPO concentration to anemia, several other possible mechanisms have been suggested. Glomerular hyperfiltration, proteinuria, renal tubular dysfunction and interstitial fibrosis are among the main culprits. On the other hand, systemic effects such as chronic inflammation, autonomic neuropathy and the renin-angiotensin system are also involved. Finally, several medications are considered to aggravate anemia associated with DN. Since anemia is an important predictor of quality of life and is implicated in the increased burden of cardiovascular morbidity and mortality, further research is required to elucidate its pathogenesis in diabetic patients.

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Section: Introductionmentioning

confidence: 99%

Less known pathophysiological mechanisms of anemia in patients with diabetic nephropathy

Παππά¹,

Dounousi

Duni

et al. 2015

Int Urol Nephrol

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show abstract

“…It is also considered as a key indicator of chronic kidney disease and an important cardiovascular risk factor [2,3]. Previous studies have shown that the incidence of anemia in diabetic patients is mostly associated with the presence of renal insufficiency.…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk of anemia in type-2 diabetic patients in the absence of renal impairment

Adejumo¹,

Dimkpa²,

Ewenighi³

et al. 2012

Health

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Aim: To determine the incidence of anemia in type-2 diabetic patients with normal renal function and assess the association of other factors related to diabetes with the risk of anemia. Methods: The study group comprised 72 patients with type-2 diabetes. Patients were divided into groups according to glycemic control, gender and age. Serum creatinine, hematocrit, hemoglobin concentration, blood glucose and glycated hemoglobin (HbA1c) of subjects were measured. The presence of anemia was defined by a hemoglobin level < 13.0 g/dL in men and <12.0 g/dL in women. Normal renal function (i.e. absence of renal impairment) was defined as serum creatinine level < 1.5 mg/dL. Results: 15.3% of the patients had anemia. The odds of developing anemia was higher in patients with poorly controlled diabetes (HbA1c > 7.5%) compared to those with controlled diabetes (≤7.5%) and in patients of age ≥ 60 yrs compared to those of age < 60 yrs (p < 0.05). The odds of anemia was similar in males and females (p = 0.26). Conclusion: This study indicated that poor glycemic control and old age are associated with the incidence of anemia in type-2 diabetics with normal renal function. Our findings suggest that treatment criteria for diabetes should include routine hematological tests and take into consideration the inevitable consequences of ageing, and poor glycemic control.

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“…It has demonstrated potency similar to that of aluminium in the pre-clinical setting [17], but lacks aluminium-like toxicity in bone [18,19,20]. Lanthanum is poorly absorbed from the intestinal tract, with peak steady-state plasma concentrations in dialysis patients of approximately 1 ng/ml.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Efficacy and Tolerability of Lanthanum Carbonate: Results from a 3-Year Study

et al. 2005

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Background: Control of serum phosphate over the long term is essential in patients with end-stage renal disease. Six-month and 2-year extensions to a 6-month study evaluated the long-term safety, tolerability and efficacy of the new phosphate binder lanthanum carbonate. Methods: Patients who participated in a 6-month, randomized trial comparing lanthanum carbonate with calcium carbonate were eligible for a 24-week, open-label extension. Lanthanum carbonate-treated patients continued taking their established maintenance dose (‘continued-lanthanum group’) and calcium carbonate-treated patients switched to lanthanum carbonate, 375–3,000 mg/day (‘switch group’). Patients could also enter a further 2-year extension. Efficacy parameters, including serum phosphate, were monitored. Results: Mean serum phosphate was ∼1.80 mmol/l throughout the trial. The percentage of patients with controlled serum phosphate (≤1.80 mmol/l) after the 6-month extension was 63.3 and 58.4% in the continued-lanthanum and switch groups, respectively; after the 2-year extension, 54.4% of patients had controlled serum phosphate. After discontinuation of calcium carbonate and initiation of lanthanum carbonate, the hypercalcemia incidence was 2.7%, compared with 20.2% during the double-blind phase. Calcium × phosphate product was maintained at an acceptable level. Lanthanum carbonate was well tolerated; adverse events were mild/moderate and mainly gastrointestinal. Conclusions: Lanthanum carbonate maintains effectiveness with continued tolerability for up to 3 years.

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How should we manage anaemia in patients with diabetes?

Cited by 77 publications

References 40 publications

Less known pathophysiological mechanisms of anemia in patients with diabetic nephropathy

Less known pathophysiological mechanisms of anemia in patients with diabetic nephropathy

Incidence and risk of anemia in type-2 diabetic patients in the absence of renal impairment

Long-Term Efficacy and Tolerability of Lanthanum Carbonate: Results from a 3-Year Study

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