Impact of diabetes on haemoglobin levels in renal disease

Ravanan, Rommel; Spiro, Jennifer; Mathieson, P. W.; Smith, Richard

doi:10.1007/s00125-006-0514-y

Cited by 25 publications

(17 citation statements)

References 33 publications

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“…33 We also found, as others did, that diabetic nephropathy is related to a higher risk for anemia, independent of GFR level. 29,33,34 We otherwise cannot rule out the possibility that the presence of other comorbidities in these patients with CKD may explain, at least in part, the relatively high prevalence of anemia observed in stage 2 and early stage 3, without demonstration of an erythropoietin-dependent mechanism linked to the moderate decrease in GFR. A new finding, to the best of our knowledge, is that obesity is associated with a lower risk for anemia.…”

Section: Discussionmentioning

confidence: 91%

Timing of Onset of CKD-Related Metabolic Complications

Moranne

Froissart²,

Rossert³

et al. 2009

Journal of the American Society of Nephrology

419

283

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Chronic kidney disease (CKD) guidelines recommend evaluating patients with GFR Ͻ60 ml/min per 1.73 m 2 for complications, but little evidence supports the use of a single GFR threshold for all metabolic disorders. We used data from the NephroTest cohort, including 1038 adult patients who had stages 2 through 5 CKD and were not on dialysis, to study the occurrence of metabolic complications. GFR was measured using renal clearance of 51 Cr-EDTA (mGFR) and estimated using two equations derived from the Modification of Diet in Renal Disease study. As mGFR decreased from 60 to 90 to Ͻ20 ml/min per 1.73 m 2 , the prevalence of hyperparathyroidism increased from 17 to 85%, anemia from 8 to 41%, hyperphosphatemia from 1 to 30%, metabolic acidosis from 2 to 39%, and hyperkalemia from 2 to 42%. Factors most strongly associated with metabolic complications, independent of mGFR, were younger age for acidosis and hyperphosphatemia, presence of diabetes for acidosis, diabetic kidney disease for anemia, and both male gender and the use of inhibitors of the renin-angiotensin system for hyperkalemia. mGFR thresholds for detecting complications with 90% sensitivity were 50, 44, 40, 39, and 37 ml/min per 1.73 m 2 for hyperparathyroidism, anemia, acidosis, hyperkalemia, and hyperphosphatemia, respectively. Analysis using estimated GFR produced similar results. In summary, this study describes the onset of CKD-related complications at different levels of GFR; anemia and hyperparathyroidism occur earlier than acidosis, hyperkalemia, and hyperphosphatemia.

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Section: Discussionmentioning

confidence: 91%

Timing of Onset of CKD-Related Metabolic Complications

Moranne

Froissart²,

Rossert³

et al. 2009

Journal of the American Society of Nephrology

419

283

View full text Add to dashboard Cite

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“…9 Anemia in an early DMN patient is more severe than in patients with kidney disease of other origins. 10,11 Although severe anemia in patients with early DMN is a well-known issue, the causes remain unclear. 3,[12][13][14][15][16][17] In this study, we investigated the possible factors that are related to the severity of anemia in DMN patients with serum creatinine (SCr) concentrations that were 2 mg/dL or less.…”

Section: Introductionmentioning

confidence: 99%

Association of Hypoalbuminemia with Severe Anemia in Patients with Diabetic Nephrosclerosis

et al. 2012

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Background: Anemia in patients with early diabetes mellitus nephrosclerosis (DMN) is more severe than in patients with kidney disease of other origins, and the mechanism for this remains unclear. In this study, we carried out a retrospective study in order to identify the factors associated with anemia in patients with DMN. Methods: To elucidate the factors that influence the severity of anemia in patients with DMN, we carried out a retrospective follow-up study of 124 biopsy-proven DMN cases [mean (SE) age, 55.3 (1.2) years; range, 18-78 years; male/female, 80/44]. First, a cluster analysis was performed using red blood cell counts and hemoglobin (Hb) and hematocrit levels. We then divided the clusters with regard to renal prognosis and survival and carried out simple and multifactorial analysis of clinical data, including the body mass index, age, systolic blood pressure (BP), diastolic BP, duration after the diagnosis of diabetes mellitus, serum albumin levels, blood urea nitrogen (BUN) concentrations, serum creatinine concentrations, the estimated glomerular filtration rate (eGFR) validated in the Japanese population, iron levels, total cholesterol levels, triglyceride levels, fasting blood sugar levels, HbA1c levels, urinary protein secretion, and pathohistological parameters. Results: The factors that were significantly associated with the cluster group that showed severe anemia were sex (p = 0.0162), hypoalbuminemia (p < 0.0001), high BUN concentrations (p = 0.0020), low eGFR (p = 0.0104), and Kimmelstiel-Wilson nodules (p = 0.0022). In addition, hypoalbuminemia (p = 0.0277), high BUN concentrations (p = 0.0338), and a low eGFR (p = 0.0417) were significantly associated with this group in a multifactorial analysis. Conclusion: Our data strongly suggest that hypoalbuminemia is associated with severe anemia in DMN patients.

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“…Epidemiological studies suggest that anemia in patients with diabetes often remains unrecognized and undiagnosed [7,8] . Many patients with diabetes suffer from diabetic nephropathy, and the reduced hemoglobin (Hb) values found in diabetics may be simply the consequence of re-nal anemia due to erythropoietin deficiency [9] . However, smaller studies have provided evidence that anemia in patients with diabetic nephropathy occurs earlier than in patients with other renal diseases and it may even be independent of renal function [10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Hemoglobin Concentrations Are Closely Linked to Renal Function in Patients with Type 1 or 2 Diabetes Mellitus

Wolf¹,

Müller²,

Hunger-Battefeld³

et al. 2008

Kidney Blood Press Res

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Background/Aims: It has been reported that anemia is more common in patients with diabetes mellitus, and that it occurs early in the disease process. Methods: In this study, we evaluated hemoglobin (Hb) values of patients with diabetes type 1 or 2 from a large collective receiving care from a tertiary center. A total of 751 patients with type 1 diabetes and 3,306 patients with type 2 were studied. Correlations were calculated for Hb with the following parameters: metabolic control (HbA_1c and blood glucose), renal function [estimated glomerular filtration rate (eGFR), serum creatinine, albuminuria, proteinuria], blood leukocytes, duration of diabetes and use of ACE inhibitors/AT1-receptor antagonists. Results: 17% of patients with type 1 diabetes and 14% of those with type 2 had anemia [defined as an Hb <8.5 mmol/l (<13.68 g/dl) in men and <7.5 mmol/l (<12.07 g/dl) in women). There was a close positive correlation between Hb and eGFR, and a negative correlation with albuminuria and proteinuria. These close associations were also confirmed with linear regression analysis. A significant negative correlation was observed between serum creatinine levels and Hb. There was no negative correlation between actual Hb and mean HbA_1c in the individual follow-up periods. No correlation was found between blood glucose (morning and postprandial blood glucose) and Hb. Blood leukocyte numbers, as a parameter of systemic inflammation, were not correlated with Hb. The use of ACE inhibitors/AT1-receptor antagonists had no adverse effect on Hb in our study cohort. Conclusion: No negative effects of metabolic control on Hb could be demonstrated in this study.

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Impact of diabetes on haemoglobin levels in renal disease

Abstract: Aims/hypothesis Anaemia is a common complication of renal impairment.

Cited by 25 publications

References 33 publications

Timing of Onset of CKD-Related Metabolic Complications

Timing of Onset of CKD-Related Metabolic Complications

Association of Hypoalbuminemia with Severe Anemia in Patients with Diabetic Nephrosclerosis

Hemoglobin Concentrations Are Closely Linked to Renal Function in Patients with Type 1 or 2 Diabetes Mellitus

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