Revisiting the Role of Chronic Kidney Disease and Its Association With Anemia in Diabetics and Non-Diabetics: A Cross Sectional Audit Of 450 Cases
Keywords:
Chronic kidney disease, Anemia, Diabetes, Iron deficiency anemiaAbstract
BACKGROUND:Â Anemia is twice common in diabetics compared with non-diabetics. The etiopathogenesis of anemia in diabetes is multifactorial [Chronic Kidney Disease (CKD), Iron Deficiency Anemia (IDA), B12 and folate deficiency, etc]. Anemia in diabetic patients prior to the evidence of renal impairment is rarely reported.
OBJECTIVE:Â To determine the role of CKD and other etiological factors of anemia in diabetics and non-diabetics. To correlate the degree of anemia with severity of CKD and glycemic status.
METHODS:Â A cross-sectional study carried out in SRM Hospital and Research Centre, Chennai. Total 450 subjects (150 controlled & 150 poorly controlled diabetics, 150 non-diabetics) with equal number of anemic and not-anemic patients in each group were included. Further categorized into those with CKD and without CKD.
RESULTS:Â In our study, only 33% anemic patients with diabetes had low eGFR Â and CKD (p<0.05). Among the rest 67% majority of anemia in diabetics was due to IDA which became evident from low iron profile and microcytic blood picture. As CKD progressed, anemia worsened. Moreover poorly controlled diabetics with CKD showed statistical significant difference between anemic and not-anemic patients. Anemia was highly prevalent in females and CKD in males in both diabetics and non-diabetics.
CONCLUSION:Â In this study we insist on the utter importance of evaluating other etiological factors apart from CKD such as IDA for accurate diagnosis, treatment of anemia in diabetics and thereby preventing the prognosis of complications.
DOI:Â 10.21276/APALM.1590
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25.Inaba M, Okuno S, Kumeda Y, Yamada S, Imanishi Y, Tabata T, et al. Glycated albumin is a better glycemic indicator than glycated hemoglobin values in hemodialysis patients with diabetes: effect of anemia and erythropoietin injection. J Am Soc Nephrol. 2007;18:896-903.
26.Chujo K, Shima K, Tada H, Oohashi T, Minakuchi J, Kawashima S. Indicators for blood glucose control in diabetics with end-stage chronic renal disease: GHb vs. glycated albumin (GA). J Med Invest. 2006;53:223-8.
27.Riveline JP, Teynie J, Belmouaz S, Franc S, Dardari D, Bauwens M, et al. Glycaemic control in type 2 diabetic patients on chronic haemodialysis: use of a continuous glucose monitoring system. Nephrol Dial Transplant. 2009;24:2866-71.
28.Vos FE, Schollum JB, Coulter CV, Manning PJ, Duffull SB, Walker RJ. Assessment of markers of glycaemic control in diabetic patients with chronic kidney disease using continuous glucose monitoring. Nephrol. 2012;17:182-8.
29.Hsu CY, Bates DW, Kuperman GJ, Curhan GC. Relationship between hematocrit and renal function in men and women. Kidney Int. 2001;59:725-31.
30.Radtke HW, Claussner A, Erbes PM, Scheuermann EH, Schoeppe W, Koch KM. Serum erythropoietin concentration in chronic renal failure: relationship to degree of anemia and excretory renal function. Blood. 1979;54:877-84.
31.Chandra M, Clemons GK, McVicar MI. Relation of serum erythropoietin levels to renal excretory function: evidence for lowered set point for erythropoietin production in chronic renal failure. J Pediatr. 1988;113:1015-21.
32.Bonomini M, Del Vecchio L, Sirolli V, Locatelli F. New treatment approaches for the anemia of CKD. Am J Kidney Dis. 2016;67:133-42.
2.Bonakdaran S, Gharebaghi M, Vahedian M. Prevalence of anemia in type 2 diabetes and role of renal involvement. Saudi J KidneyDisTranspl. 2011;22:286-290.
3.Abate A, Birhan W, Alemu A. Association of anemia and renal function test among diabetes mellitus patients attending Fenote Selam Hospital, West Gojam, Northwest Ethiopia: a cross sectional study. BMC Hematol. 2013;13:1.
4.Thomas MC, Cooper ME, Rossing K, Parving HH. Anaemia in diabetes: is there a rationale to TREAT?. Diabetologia. 2006;49:1151-7.
5.Jones SC, Smith D, Nag S, Bilous MT, Winship S, Wood A, Bilous RW. Prevalence and nature of anaemia in a prospective, populationâ€based sample of people with diabetes: Teesside anaemia in diabetes (TAD) study. Diabet Med. 2010;27:655-9.
6.Al-Khoury S, Afzali B, Shah N, Covic A, Thomas S, Goldsmith DJ. Anaemia in diabetic patients with chronic kidney disease—prevalence and predictors. Diabetologia. 2006;49:1183-9.
7.El-Achkar TM, Ohmit SE, McCullough PA, Crook ED, Brown WW, Grimm R, et al. Kidney Early Evaluation Program: Higher prevalence of anemia with diabetes mellitus in moderate kidney insufficiency: The Kidney Early Evaluation Program. Kidney Int. 2005;67:1483-8.
8.Winkler AS, Marsden J, Chaudhuri KR, Hambley H, Watkins PJ. Erythropoietin depletion and anaemia in diabetes mellitus. Diabet med. 1999;16:813-9.
9.Bosman DR, Winkler AS, Marsden JT, Macdougall IC, Watkins PJ. Anemia with erythropoietin deficiency occurs early in diabetic nephropathy. Diabetes care. 2001;24:495-9.
10.Ishimura E, Nishizawa Y, Okuno S, Matsumoto N, Emoto M, Inaba M, et al. Diabetes mellitus increases the severity of anemia in non-dialyzed patients with renal failure. J nephrol. 1997;11:83-6.
11.Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration?. Blood. 2006;107:1747-50.
12.Lam AP, Gundabolu K, Sridharan A, Jain R, Msaouel P, Chrysofakis G. Multiplicative interaction between mean corpuscular volume and red cell distribution width in predicting mortality of elderly patients with and without anemia. Am J hematol. 2013;88:E245-9.
13.Isakov E, Froom P, Henig C, Barak M. Anemia and estimated glomerular filtration rates. Ann Clin Lab Sci. 2014;44:419-24.
14.Liu X, Qiu X, Shi C, Huang H, Huang J, Li M. Modified glomerular filtration rate-estimating equations developed in asiatic population for chinese patients with type 2 diabetes. Int J Endocrinol. 2014.
15.Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al.Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005;67:2089-100.
16.Dikow R, Schwenger V, Schömig M, Ritz E. How should we manage anaemia in patients with diabetes?. Nephrol Dial Transplant. 2002;17:67-72.
17.Yun YS, Lee HC, Yoo NC, Song YD, Lim SK, Kim KR, et al. Reduced erythropoietin responsiveness to anemia in diabetic patients before advanced diabetic nephropathy. Diabetes res clin pract. 1999;46:223-9.
18.Biaggioni I, Robertson D, Krantz S, Jones M, Haile V. The anemia of primary autonomic failure and its reversal with recombinant erythropoietin. Ann Intern med. 1994;121:181-6.
19.Cawood TJ, Buckley U, Murray A. Prevalence of anemia in patients with diabetes mellitus. Ir J Med Sci 2006;175:25-27.
20.Thomas MC, MacIsaac RJ, Tsalamandris C, Molyneaux L, Goubina I, Fulcher G, et al. The burden of anaemia in type 2 diabetes and the role of nephropathy: a cross-sectional audit. Nephrol Dial Transplant. 2004;19:1792-7.
21.Adeoye S, Abraham S, Erlikh I, Sarfraz S, Borda T, Yeung L. Anaemia and Haemoglobin A1c level: Is there a case for redefining reference ranges and therapeutic goals?. BJMP. 2014;7:6.
22.Naets JP, Wittek M. The mechanism of action of androgens on erythropoiesis. Ann N Y Acad Sci. 1968;149:366-76.
23.Holdsworth S, Atkins RC, De Kretser DM. The pituitary-testicular axis in men with chronic renal failure. N Engl J Med. 1977;296:1245-9.
24.Phillips GB, Tuck CH, Jing TY, Boden-Albala B, Lin IF, Dahodwala N, et al. Association of hyperandrogenemia and hyperestrogenemia with type 2 diabetes in Hispanic postmenopausal women. Diabetes care. 2000;23:74-9.
25.Inaba M, Okuno S, Kumeda Y, Yamada S, Imanishi Y, Tabata T, et al. Glycated albumin is a better glycemic indicator than glycated hemoglobin values in hemodialysis patients with diabetes: effect of anemia and erythropoietin injection. J Am Soc Nephrol. 2007;18:896-903.
26.Chujo K, Shima K, Tada H, Oohashi T, Minakuchi J, Kawashima S. Indicators for blood glucose control in diabetics with end-stage chronic renal disease: GHb vs. glycated albumin (GA). J Med Invest. 2006;53:223-8.
27.Riveline JP, Teynie J, Belmouaz S, Franc S, Dardari D, Bauwens M, et al. Glycaemic control in type 2 diabetic patients on chronic haemodialysis: use of a continuous glucose monitoring system. Nephrol Dial Transplant. 2009;24:2866-71.
28.Vos FE, Schollum JB, Coulter CV, Manning PJ, Duffull SB, Walker RJ. Assessment of markers of glycaemic control in diabetic patients with chronic kidney disease using continuous glucose monitoring. Nephrol. 2012;17:182-8.
29.Hsu CY, Bates DW, Kuperman GJ, Curhan GC. Relationship between hematocrit and renal function in men and women. Kidney Int. 2001;59:725-31.
30.Radtke HW, Claussner A, Erbes PM, Scheuermann EH, Schoeppe W, Koch KM. Serum erythropoietin concentration in chronic renal failure: relationship to degree of anemia and excretory renal function. Blood. 1979;54:877-84.
31.Chandra M, Clemons GK, McVicar MI. Relation of serum erythropoietin levels to renal excretory function: evidence for lowered set point for erythropoietin production in chronic renal failure. J Pediatr. 1988;113:1015-21.
32.Bonomini M, Del Vecchio L, Sirolli V, Locatelli F. New treatment approaches for the anemia of CKD. Am J Kidney Dis. 2016;67:133-42.
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Rajagopal L, Arunachalam S, Ganapathy S, Ramraj B, Raja V. Revisiting the Role of Chronic Kidney Disease and Its Association With Anemia in Diabetics and Non-Diabetics: A Cross Sectional Audit Of 450 Cases. Ann of Pathol and Lab Med [Internet]. 2017 Dec. 22 [cited 2025 Feb. 5];4(6):A742-748. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/apalm1590
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Copyright (c) 2017 Lavanya Rajagopal, Sundaram Arunachalam, Shivashekar Ganapathy, Balaji Ramraj, Veena Raja
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