Anemia in type 2 diabetic patients and correlation with kidney function in a tertiary care sub-Saharan African hospital: a cross-sectional study

Abstract

BackgroundAnemia is common in diabetic patients and increases morbidity and mortality, but its burden has been less well characterized in sub-Saharan Africans. We determined the prevalence of anemia and investigated the related factors, with a particular focus on the role of declining renal function, in type 2 diabetic patients attending a tertiary health care institution in Cameroon.MethodsHemoglobin (Hb) levels were measured in a consecutive sample of patients with type 2 diabetes, who reported for annual review at the outpatient section of the Douala General Hospital in 2013. Patients were classified as anemic according to the World Health Organisation criteria (Hb < 12 g/dl for females and Hb < 13 g/dl for males). Estimated glomerular filtration rate (eGFR) was calculated using the abbreviated Modification of Diet in Renal Disease Study Group formula. Determinants of Hb concentration and anemia were investigated using multivariable logistic regressions.ResultsA total of 636 patients were examined including 263 (prevalence rate 41.4 %) who had anemia. The prevalence of anemia increased significantly with deteriorating kidney function, although up to 31.9 % of patients with normal kidney function had anemia. Compared with their non-anemic counterparts, anemic diabetic patients were older, had longer duration of diabetes, lower eGFR, higher prevalence of proteinuria and diabetic retinopathy (all p < 0.05). In multivariable logistic regressions, eGFR (p = 0.001) and presence of retinopathy (p = 0.023) were the independent determinants of prevalent anemia.ConclusionsThe prevalence of anemia is high in type 2 diabetic patients attending referral institutions in Cameroon, including among those without chronic kidney disease. Routine screening for anemia in all diabetic patients may aid early identification and correction as appropriate.

Anemia prevalence and its impact on health‐related quality of life in Indian diabetic kidney disease patients: Evidence from a cross‐sectional study

“…A similar finding was reported by Kazmi et al in a retrospective cohort study. This finding was also supported by Feteh et al and New et al, they also found a linear relation between the eGFR and hemoglobin level. Several cross‐sectional studies reported older age, long duration of diabetes, and CKD as an independent predictor of anemia .…”

“…Previously published studies reported the prevalence of anemia among T2DM patients between 12 and 41.4% . So, in this study, the proportion was estimated to be 25% with a precision of 5% and a z value of 1.96.…”

“…A multicentre cross‐sectional study from Barcelona and China also reported a high prevalence of anemia (58.5 and 51.5%) in patients with nondialysis CKD . Studies from Korea (44.9%), Cameroon (41.4%), Iran (30%), and United States (15.4%) reported a lower prevalence of anemia person with diabetes with altered kidney function . The reason for lower prevalence could be attributed to the geographical variation, the age of the study population, and living style.…”

Understanding the determinants of hemoglobin and iron status: adolescent–adult women comparisons in SANHANES‐1

“…Iron stores/red blood cells can also be diminished during menstruation, during bouts of infections, and as a result of chronic non‐communicable diseases (NCDs) . Hence, the research done in Africa has shown that this condition is more prevalent/common among women of reproductive age, people who have limited access to basic needs (such as sanitation and treated water), and people exposed to infectious diseases and those at risk of NCDs …”

“…Recent localized studies in SA also increased awareness of other important factors that fuel anemia in the country . These factors include inflammation due to infectious diseases (tuberculosis (TB) and HIV/AIDS), chronic diseases (especially chronic kidney failure), and selected drug therapies .…”