Prevalence and nature of anaemia in a prospective, population‐based sample of people with diabetes: Teesside anaemia in diabetes (TAD) study

Abstract

Aims Anaemia occurs in 25% of people attending hospital diabetes clinics, but this may not be representative of all people with diabetes. We aimed to determine the prevalence of anaemia in a prospective population-based sample stratified by estimated glomerular filtration rate (eGFR) using the 4-point Modification of Diet in Renal Disease (MDRD) formula.Methods All 7331 patients on our district register were stratified by eGFR. Seven hundred and thirty were approached by letter on two occasions. Two hundred and thirty-four (32%) returned questionnaires and blood samples. Responders (R), nonresponders (NR) and the whole cohort (C) were similar: mean AE sd age R 61.7 AE 12.7 years; NR 61.3 AE 15.1 years; C 61.8 AE 14.2 years; diabetes duration R 8.8 AE 8.6 years; NR 8.2 AE 7.9 years; C 7.5 AE 7.8 years, Type 1 diabetes R 10.1%, NR 10.8%, C 9.4%. Anaemia was defined using World Health Organization criteria: haemoglobin < 13 g ⁄ dl for men, < 12 g⁄ dl for women.Results Previously undiagnosed anaemia was present in 15% of the whole group, 36% with eGFR < 60 ml ⁄ min per 1.73 m 2 and 9% of those with eGFR > 60 ml ⁄ min per 1.73 m 2 . Anaemia was as a result of erythropoietin deficiency in 34%, abnormal haematinics in 40% and was unexplained in 26% of patients. Five per cent of the patients had anaemia below the treatment threshold of 11 g ⁄ dl.Conclusions The prevalence of unrecognized anaemia in population-based cohorts is lower than that in hospital-based studies. Current clinical surveillance in the UK is failing to detect anaemia in stage 3-5 chronic kidney disease (eGFR < 60 ml ⁄ min per 1.73 m 2 ) and current guidelines will not detect 9% of diabetic patients with anaemia and an eGFR > 60 ml ⁄ min per 1.73 m 2 . Diabet. Med. 27, 655-659 (2010)

Anemia in Patients with Diabetes Mellitus: Prevalence and Progression

“…The percentage of anemic patient with GFR<60mL/min/ 1.73 m 2 (46%) which is comparable to the result from other study (36%) [5]. However, it is about two time more when compared to nonanemic patient in the same stages (17.8%) and this is may be explained that anemia increase the progression of renal impairment as compared to those without anemia who are allocated in the early stages of kidney disease (Figure 3).…”

“…However, it is about two time more when compared to nonanemic patient in the same stages (17.8%) and this is may be explained that anemia increase the progression of renal impairment as compared to those without anemia who are allocated in the early stages of kidney disease (Figure 3). Although anemia in diabetic patient correlated with degree of renal impairment, in our study anemia was six times more common (53.9%), compared to the previous study (9%) for the same GFR value (GFR>60 mL/min/1.73 m 2 ) and half of them in stage one kidney disease unlike in previous study [5,16,17]. Despite the predominance of patients with anemia in the early stages of chronic kidney disease, their numbers are progressively decreasing with progression of kidney disease and this may be explained by increased morbidity and mortality as anemia closely associated with vascular complications.…”

“…The prevalence of anemia in our study population is 55.5%, which is two to three times more common as compared to the result from previous studies (19-25%) [5,16]. Approximately one in two patients (126/227) had anemia as defined by gender-specific WHO guidelines.…”

“…Anemia also develops earlier and is more severe in patients with diabetes than in patients with renal impairment from other causes [4]. Additionally, the risk of anemia is higher in people with diabetic nephropathy compared with people with nephropathy from other causes and is associated with a more rapid decline in the GFR [5,6]. However, it develops whilst serum creatinine is within the normal range in 5% of the cases [5].…”

“…Additionally, the risk of anemia is higher in people with diabetic nephropathy compared with people with nephropathy from other causes and is associated with a more rapid decline in the GFR [5,6]. However, it develops whilst serum creatinine is within the normal range in 5% of the cases [5]. Recent studies have linked anemia with relatively low serum erythropoietin in persons with either type 1 or type 2 diabetes, even without advanced kidney disease or overt uremia [7].…”