Prevalence of anaemia and the contribution of functional iron deficiency in diabetes related chronic kidney disease


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Abstract

Anaemia is often an unrecognised complication of diabetes that has an adverse effect on the progression of diabetes related complications. Anaemia predicts mortality in diabetes related chronic kidney disease (CKD). Contributors to its development include absolute and/or functional iron deficiency and erythropoietin insufficiency. This study aimed to look at the prevalence of anaemia and markers of iron deficiency in patients with diabetes related CKD.An analysis was done of the results from all patients (225 men, 93 women; mean age 70 years) attending joint diabetes-renal clinics over a 12-month period. Haemoglobin (Hb) was measured in 88%. The mean Hb was 12.6g/dl in men and 11.7g/dl in women. A total of 21.5% (11.5% men, 10% women) had Hb <11g/dl who should have anaemia management as per National Institute for Health and Clinical Excellence guidelines. Among the anaemic population, CKD stage 3 was present in 25% of men and in 8% of women, with CKD stage 4 present in 20% of men and in 32% of women. Fifty-three percent had absolute iron deficiency (serum ferritin <100μg/L) and 41% had inadequate iron stores (serum ferritin between 100 and 500μg/L). Functional iron deficiency defined by serum ferritin >100μg/L and red cell hypochromasia ≥6% was noted in 21.6% of anaemic patients.Anaemia is a frequent finding in patients with diabetes related CKD. A significant proportion of patients had functional iron deficiency that required iron therapy for optimisation of their iron stores before starting erythropoiesis-stimulating agents. Measurement of red cell hypochromasia is a valuable tool to detect this group of patients. Copyright © 2010 John Wiley & Sons.

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