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 diabetesโrenal clinics over a 12โmonth 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. Fiftyโthree percent had absolute iron deficiency (serum ferritin <100ฮผg/L) and 41% had inadequate iron stores (serum ferritin between 100 and 500ฮผg/L). Functional iron deficiency defined by serum ferritin >100ฮผg/L and red cell hypochromasia โฅ6% 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 erythropoiesisโstimulating agents. Measurement of red cell hypochromasia is a valuable tool to detect this group of patients. Copyright ยฉ 2010 John Wiley & Sons.