Anemia and Diabetes

Deray, Gilbert; Heurtier, A.; Grimaldi, A.; Launay-Vacher, Vincent; Bagnis, Corinne Isnard

doi:10.1159/000081058

Cited by 64 publications

(64 citation statements)

References 75 publications

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“…Therefore, evaluation of anemia as a risk factor for adverse outcomes is of particular importance in individuals with diabetes. There is also evidence that anemia is more severe and occurs at an earlier stage of kidney disease in patients with diabetic compared with nondiabetic CKD (17,34). Consequently, the effect of anemia and CKD on outcomes may be different in patients with and without diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes is the leading cause of kidney disease and kidney failure in the United States (16). Anemia is often more severe and occurs at an earlier stage of CKD in individuals with diabetes compared with those with other causes of CKD (17,18). Furthermore, diabetes is a known risk factor for coronary artery disease and small vessel disease and may be a contributing factor to the development of LVH (19,20).…”

mentioning

confidence: 99%

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Anemia as a Risk Factor for Cardiovascular Disease and All-Cause Mortality in Diabetes

Vlagopoulos

Tighiouart

Weiner

et al. 2005

Journal of the American Society of Nephrology

294

201

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Anemia is a potential nontraditional risk factor for cardiovascular disease (CVD). This study evaluated whether anemia is a risk factor for adverse outcomes in people with diabetes and whether the risk is modified by the presence of chronic kidney disease (CKD). Persons with diabetes from four community-based studies were pooled: Atherosclerosis Risk in Communities, Cardiovascular Health Study, Framingham Heart Study, and Framingham Offspring Study. Anemia was defined as a hematocrit <36% in women and <39% in men. CKD was defined as an estimated GFR of 15 to 60 ml/min per 1.73 m 2 . Study outcomes included a composite of myocardial infarction (MI)/fatal coronary heart disease (CHD)/stroke/death and each outcome separately. Cox regression analysis was used to study the effect of anemia on the risk for outcomes after adjustment for potential confounders. The study population included 3015 individuals: 30.4% were black, 51.6% were women, 8.1% had anemia, and 13.8% had CKD. Median follow-up was 8.6 yr. There were 1215 composite events, 600 MI/fatal CHD outcomes, 300 strokes, and 857 deaths. In a model with a CKD-anemia interaction term, anemia was associated with the following hazard ratios (95% confidence intervals) in patients with CKD: 1.70 (1.24 to 2.34) for the composite outcome, 1.64 (1.03 to 2.61) for MI/fatal CHD, 1.81 (0.99 to 3.29) for stroke, and 1.88 (1.33 to 2.66) for all-cause mortality. Anemia was not a risk factor for any outcome in those without CKD (P > 0.2 for all outcomes). In persons with diabetes, anemia is primarily a risk factor for adverse outcomes in those who also have CKD.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Anemia as a Risk Factor for Cardiovascular Disease and All-Cause Mortality in Diabetes

Vlagopoulos

Tighiouart

Weiner

et al. 2005

Journal of the American Society of Nephrology

294

201

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“…World Health Organization statistics identify around 150 million people with diabetes mellitus worldwide and suggest that this figure may double by 2025 [3]. Diabetes mellitus is the single most common cause of end-stage renal disease and consequently the most common cause of renal anaemia [3].…”

Section: Introductionmentioning

confidence: 99%

“…Diabetes mellitus is the single most common cause of end-stage renal disease and consequently the most common cause of renal anaemia [3]. Patients with diabetes mellitus are also twice as likely to have anaemia as those with renal impairment from other causes [4].…”

Section: Introductionmentioning

confidence: 99%

Anaemia in diabetic patients with chronic kidney disease—prevalence and predictors

et al. 2006

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Aims/hypothesis: We investigated the relationship between haemoglobin (Hb) and diabetes in patients with renal disease. Subjects, materials and methods: All adult patients with stable chronic kidney disease attending renal or diabetic outpatient clinics in a six-month period were identified. Patients' notes and electronic patient records were used to build a comprehensive biochemical and clinical database. Results were analysed for the predictors of Hb, the severity of anaemia in both groups and the relative impact of diabetes on haemoglobin and anaemia. Results: The study group consisted of 468 patients, of whom 204 had diabetes and 264 did not. At every level of renal function haemoglobin levels were lower by an average of 10 g/l in subjects with diabetes than in those without. Likewise, anaemia was found to occur at an earlier stage of chronic kidney disease (and to be of greater severity) in diabetic patients. Independent predictors of haemoglobin included female sex, diabetes, renal function and serum albumin, with diabetes and renal function being the greatest predictors. Multiple logistic regression showed that patients with diabetes had an odds ratio of 4 for being anaemic. Had we used an estimated GFR of less than 60 ml/min to trigger investigation of anaemia, we would have detected 85% of anaemic patients. Conclusions/interpretation: Anaemia is frequently found in diabetic patients with renal disease, occurs earlier and is more severe than in similar but non-diabetic subjects. In contrast to previous publications, our findings suggest that anaemia is prevalent at the earliest stages of chronic kidney disease. We advocate an estimated GFR threshold of <60 ml/min to trigger investigation for anaemia in diabetic subjects.

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“…In Current Topics in Anemiathe cohort of >9000 patients without renal disease, DM was an independent determinant of Hb levels [24]. Many factors have been suggested additionally contributing to the pathogenesis of anemia in DM patients, such as erythropoietin deficiency due to efferent sympathetic denervation of the kidney in diabetic neuropathy, chronic inflammatory reaction leading to functional iron deficiency, non-selective urinary protein excretion leading to transferrin and erythropoietin loss and the use of RAAS blockers [5,25]. A direct comparison of anemia between matched diabetic and non-diabetic CKD patients in the epidemiologic study which included particularly large number of patients at CKD Stage 3A found out the difference between the groups, and diabetic patients had anemia two times more often than patients without diabetes (60.4 vs 26.4%).…”

Section: Anemia In Chronic Kidney Diseasementioning

confidence: 99%

Anemia in Chronic Kidney Disease and After Kidney Allotransplantation (Systematic Review)

Milovanov¹,

Lysenko²,

Milоvаnоvа³

et al. 2018

Current Topics in Anemia

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Anemia in chronic kidney disease (CKD) has been recognized as a separate independent risk factor of cardiovascular (CV) events. The aim of the review is to provide a literature summary concerning early diagnosis and treatment of anemia in CKD that may be useful for clinicians and contribute to decrease CV mortality. Literature searches were made in such major databases as: PubMed, Medline, Embase, Cochrane Library, CINAHL, Wiley Online Library, Scopus, Web of Science, e-library, and website of WHO. This search encompassed original articles, systematic reviews, and meta-analyses relevant to CKD and anemia over recent 15 years. A total of 54 references from 562 reviewed articles were selected as they met to the search criteria (anemia and CKD, including diabetes mellitus, systemic diseases and post-transplant anemia). The publications included 27 randomized controlled trials, 20 experimental studies representing new data on the links of CKD anemia and cardiovascular risk markers (cytokines, Klotho, fibroblast growth factor (FGF-23), hyperglycemia, hypoalbuminemia and some others), 4 systematic reviews and 3 clinical practice guidelines. The main attention was devoted to the analysis of the studies provided an early diagnosis of anemia, an ability to minimize the factors contributing to its severity that have allowed to improve CV and total outcomes and to reduce costs of hospital treatment of CKD patients with anemia.

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Anemia and Diabetes

Cited by 64 publications

References 75 publications

Anemia as a Risk Factor for Cardiovascular Disease and All-Cause Mortality in Diabetes

Anemia as a Risk Factor for Cardiovascular Disease and All-Cause Mortality in Diabetes

Anaemia in diabetic patients with chronic kidney disease—prevalence and predictors

Anemia in Chronic Kidney Disease and After Kidney Allotransplantation (Systematic Review)

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