Anemia and Kidney Dysfunction in Type 2 Diabetic Patients

Background and Aim: The combination of diabetes and chronic kidney disease (CKD) has become a major health problem. Observational studies indicate that low hemoglobin levels in diabetics may increase risk for progression of kidney disease and cardiovascular morbidity and mortality. The aim of this work was to determine kidney dysfunction and hemoglobin level among type 2 diabetic patients. Methods: This study included 307 patients, 169 (55%) of them were males, on the day of referral their age was 47±11 range 22 -74 years and their duration of diabetes mellitus ranged from 6-206 (mean 55±52) months. Estimated glomerular filtration rate (eGFR) by MDRD and CKD-EPI is expressed in ml/min per 1.73 m2. Anemia was defined as hemoglobin < 12 g/dl in females and < 13 g/dl in males.

Results: Prevalence of anemia was 39% of the patients, eGFR was 58 ± 25 ml/min/1.73m2, body mass index (BMI) was 28±7 kg/m2 mean hemoglobin for all patients was 12±2. There was a significant decrease in hemoglobin level in stage 3 CKD in comparison to stage1 and stage 2. Also there was a significant decrease in hemoglobin level in stage 4 in comparison to stage 1, 2, and 3. We found significant lower eGFR in anemic group 43±20 as compared to nonanemic group 68±22ml/min/1.73m2. Additionally, there was significant lower hemoglobin, hematocrite and eGFR in uncontrolled diabetic patients compared with the controlled ones.

Conclusions: Anemia is prevalent among diabetics but remains under-recognized and under-treated. Therefore, we recommend screening of anemia in diabetics even at normal eGFR, and aggressive management of diabetic anemia so as to improve quality of life and outcome for the affected patients. Further studies are recommended to determine a different hemoglobin target in diabetic patients.