Prevalence of anaemia and the contribution of functional iron deficiency in diabetes related chronic kidney disease

Abstract

Anaemia is often an unrecognised complication of diabetes that has an adverse effect on the progression of diabetes related complications. Anaemia predicts mortality in diabetes related chronic kidney disease (CKD). Contributors to its development include absolute and/or functional iron deficiency and erythropoietin insufficiency. This study aimed to look at the prevalence of anaemia and markers of iron deficiency in patients with diabetes related CKD.An analysis was done of the results from all patients (225 men, 93 women; mean age 70 years) attending joint diabetes–renal clinics over a 12‐month period. Haemoglobin (Hb) was measured in 88%. The mean Hb was 12.6g/dl in men and 11.7g/dl in women. A total of 21.5% (11.5% men, 10% women) had Hb <11g/dl who should have anaemia management as per National Institute for Health and Clinical Excellence guidelines. Among the anaemic population, CKD stage 3 was present in 25% of men and in 8% of women, with CKD stage 4 present in 20% of men and in 32% of women. Fifty‐three percent had absolute iron deficiency (serum ferritin <100μg/L) and 41% had inadequate iron stores (serum ferritin between 100 and 500μg/L). Functional iron deficiency defined by serum ferritin >100μg/L and red cell hypochromasia ≥6% was noted in 21.6% of anaemic patients.Anaemia is a frequent finding in patients with diabetes related CKD. A significant proportion of patients had functional iron deficiency that required iron therapy for optimisation of their iron stores before starting erythropoiesis‐stimulating agents. Measurement of red cell hypochromasia is a valuable tool to detect this group of patients. Copyright © 2010 John Wiley & Sons.

Prevalence of anemia of chronic disease and iron deficiency anemia among adult diabetic patients in Erbil City

“…In this study the commonest type of anaemia was ACD (72 patients, 65%). Similar results were reported from UK (56%) in 2010 8 in diabetic patients with impaired renal function. Bosman in 2001 reported a frequency of 48% 12 .…”

“…The prevalence of iron deficiency anemia in this study was 24.1% (26 patients). Higher frequency were reported in 2010 in UK (53%) 8 and in Israel in 2010 (38%) 16 while Lower frequency (12%) was reported in another study done in 2008 in UK 9 . IDA was more common in female than in male in our study.…”

“…HbA1c ranged from 6.7%-19.19% (mean 7.47%), Table 1. 8,9 . A slightly higher frequency of anemia was found among group III patients in comparison to group I and group II patients (44.5%, 41.1% and 46.6% in-group I, II and III respectively).…”

“…Health and Nutrition Examination Survey found that patients with diabetes were twice as likely to have anaemia as those with renal impairment from other causes given a similar degree of renal impairment 7 . Interestingly, reductions in haemoglobin level often occur before the onset of overt diabetic nephropathy 8 . Anaemia has been shown to impact significantly on quality of life scores leading to chronic fatigue, reduced energy levels and a lower quality of life 7 .…”