Anaemia in diabetes: is there a rationale to TREAT?

Thomas, Merlin C.; Cooper, ME; Rossing, Kasper; Parving, Hans‐Henrik

doi:10.1007/s00125-006-0215-6

Cited by 80 publications

(60 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It has been pointed out that the oxygen-erythropoietin feedback, which depends on the hypoxia-sensing system HIF-1␣, is dysregulated in diabetes; microangiopathy and progressive tubulointerstitial fibrosis increase the latency of the erythropoietin system, while production of ROS and hyperglycemia itself stabilize HIF-1␣, blunting erythropoietin response (61). Additionally, we have recently demonstrated that EPC mobilization in diabetes is defective because of HIF-1␣ downregulation (19).…”

Section: Epcs and Diabetic Nephropathymentioning

confidence: 90%

Significance of Endothelial Progenitor Cells in Subjects With Diabetes

et al. 2007

View full text Add to dashboard Cite

Section: Epcs and Diabetic Nephropathymentioning

confidence: 90%

Significance of Endothelial Progenitor Cells in Subjects With Diabetes

et al. 2007

View full text Add to dashboard Cite

“…Indeed, correction of anemia in both diabetic and nondiabetic patients with CKD has been shown to reduce hospitalization rate and hospital stay (32,33). Given the high prevalence of anemia and CKD in our diabetic population, there is a need to conduct interventional studies to examine whether optimization of the internal milieu, including correction of anemia, will reduce cardiovascular and renal risk (34).…”

Section: Discussionmentioning

confidence: 99%

Hematocrit, Independent of Chronic Kidney Disease, Predicts Adverse Cardiovascular Outcomes in Chinese Patients With Type 2 Diabetes

Tong

Kong

et al. 2006

Diabetes Care

View full text Add to dashboard Cite

1OBJECTIVE -Anemia and chronic kidney disease (CKD) are risk factors for cardiovascular diseases in diabetes. We examined the association between hematocrit, stratified by the presence of CKD, and cardiovascular events in a cohort of Chinese subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS-A total of 3,983 patients who underwent assessment for diabetes complications were recruited. Subjects were categorized into five groups. Group I included subjects with hematocrit below the normal sex-specific range. The cutoff points for groups II-V were selected to represent the distribution of the hematocrit for each sex. CKD was defined by the estimated glomerular filtration rate Ͻ60 ml/min per 1.73 m 2 . Cardiovascular events were defined as cardiovascular mortality and morbidity, including new onset of myocardial infarction, acute coronary syndrome, revascularization, heart failure, and stroke requiring hospitalization.RESULTS -A total of 294 subjects (7.4%) developed cardiovascular events during the median of 36.4 months. The rate of cardiovascular events was highest in subjects with low hematocrit (group I, 18.6%) compared with group V (3.4%, P Ͻ 0.001). The multivariate-adjusted hazard ratio for cardiovascular events diminished with increasing hematocrit (group I, 1. Growing evidence confirms the predictive role of chronic kidney disease (CKD) on cardiovascular morbidity and mortality (3,4). This is due to the constellation of conventional and nonconventional risk factors in patients who develop CKD, such as anemia, inflammation, and abnormal bone metabolism (5,6). In this regard, hematocrit is a risk factor for cardiovascular disease and all-cause mortality in patients with CKD (7), patients with left ventricular dysfunction (8), and the general population (9).Despite the close associations between CKD and diabetes, there is a paucity of information on the relationship between levels of hematocrit, CKD, and clinical outcomes in patients with type 2 diabetes. In the present study, we examined the association between hematocrit, stratified by the presence of CKD, and the development of cardiovascular events in a cohort of Chinese type 2 diabetic subjects. RESEARCH DESIGN AND METHODS -Patients with diabeteswere referred from general practitioners, general medical clinics, and other specialist clinics of the hospital to the Diabetes Centre, Prince of Wales Hospital and underwent comprehensive assessment of complications and risk factors based on the European DiabCare protocol (10). Between 1995 and 2000, 4,231 patients underwent assessments with measurement of hematocrit. Patients with type 1 diabetes (n ϭ 248), defined as acute presentation with diabetic ketoacidosis, heavy ketouria (Ͼ3ϩ), or continuous requirement of insulin within 1 year of diagnosis, were excluded from this analysis. A total of 3,983 subjects were included in the final analysis. Informed consent was obtained from all patients at the time of assessment to allow use of data for re-

show abstract

“…Predominant tubulointerstitial disease is associated with damage to the peritubular interstitial cells that produce erythropoietin. As a result, patients with diabetes may be prone to erythropoietin deficiency and are nearly twice as likely to have anemia compared with patients with nondiabetic CKD and comparable eGFR (40). Insulin is a cofactor for parathyroid hormone release; therefore, insulin deficiency and/or resistance may be associated with lower parathyroid hormone levels than in other types of CKD (41), which may predispose patients with DKD to adynamic bone disease.…”

Section: Natural Historymentioning

confidence: 99%