Document Detail

Anemia with erythropoietin deficiency occurs early in diabetic nephropathy.
MedLine Citation:
PMID:  11289474     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The normochromic normocytic anemia of erythropoietin (EPO) deficiency is recognized in advanced renal failure but not in early renal disease. The aim of this study was to determine whether anemia with EPO deficiency is found in type 1 diabetic patients with diabetic nephropathy in the absence of advanced renal failure and to compare them with patients with nondiabetic renal disease of similar severity. RESEARCH DESIGN AND METHODS: A total of 27 type 1 diabetic patients with diabetic nephropathy (DN), defined as having persistent proteinuria (mean 1,086 mg/day [CI 120-5,1901), a serum creatinine < or = 180 micromol/l, and retinopathy, were compared with 26 nondiabetic patients with glomerulonephritis (GN) and persistent proteinuria (1,874 mg/day [349-5,005]). The Hb concentration, red cell indexes, and serum EPO levels were measured, and other causes for the anemia were excluded. The EPO values were compared with a normal reference range obtained from nondiabetic patients with a microcytic anemia. The DN patients were tested for signs of diabetic peripheral and autonomic neuropathy. RESULTS: We found that 13 of the 27 DN patients were anemic (Hb 10.6 +/- 0.9 g/dl) in marked contrast to none of the GN patients (Hb 13.7 +/- 1.4 g/dl, P < 0.005). In the DN group, serum EPO concentrations failed to increase in response to anemia compared with the response seen in patients with microcytic anemia. Thus, the anemia of the DN group was associated with EPO deficiency. The anemic DN patients showed evidence of more severe proteinuria and diabetic neuropathy than the nonanemic DN patients. CONCLUSIONS: Anemia associated with EPO deficiency can occur early in DN before the onset of advanced renal failure, but does not normally occur in nondiabetic renal disease of similar severity. The pathogenesis requires elucidation.
D R Bosman; A S Winkler; J T Marsden; I C Macdougall; P J Watkins
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Diabetes care     Volume:  24     ISSN:  0149-5992     ISO Abbreviation:  Diabetes Care     Publication Date:  2001 Mar 
Date Detail:
Created Date:  2001-04-05     Completed Date:  2001-06-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7805975     Medline TA:  Diabetes Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  495-9     Citation Subset:  IM    
King's Diabetes Centre, King's College Hospital, London, UK.
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MeSH Terms
Anemia / blood,  complications*
Biological Markers / blood
Blood Pressure
Diabetes Mellitus, Type 1 / blood,  physiopathology*
Diabetic Nephropathies / blood*
Erythropoietin / blood*,  deficiency
Heart Rate
Hemoglobins / analysis
Middle Aged
Reference Values
Reproducibility of Results
Reg. No./Substance:
0/Biological Markers; 0/Hemoglobins; 11096-26-7/Erythropoietin

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