A study of functional erythropoietin deficiency in patients with type-2 diabetes and anemia
Abstract
Anemia is a common finding in diabetes, particularly in patients with diabetic nephropathy or renal impairment. This study was designed to assess the prevalence of functional erythropoietin deficiency in patients with type-2 diabetes and anemia. In a hospital based observational descriptive study, 60 diagnosed diabetic patients were included. They were divided into 2 groups: group I had diabetic patients without anemia with/without diabetic nephropathy and group II had type 2 diabetics with anemia with/without diabetic nephropathy. Most of the subjects (50%) in group I without diabetic nephropathy had their serum erythropoietin levels in the range of 15-30 IU/L with a mean value of 19.01 2.11 IU/L. All the subjects in group I who had diabetic nephropathy had their serum EPO levels between 15-30 IU/L with a mean value 24.173.03 IU/L. In group II with diabetic nephropathy, most of the subjects (72.5%) had their serum EPO value <15 IU/L with a mean value of 10.45 1.61 IU/L and all the subjects without diabetic nephropathy had their serum EPO level above 30 IU/L with mean value 36.413.0 IU/L. Comparison of both groups showed highly significant difference in EPO levels statistically (P<0.001). This study suggest further researches to find out relation of functional erythropoietin deficiency with a pattern of damage to the renal tubulointerstitium and microvasculature in diabetic kidney restricting the production of erythropoietin to maintain red cell mass in response to tissue hypoxia or a defect of "Anemia sensing" mechanism.
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Introduction
The world health organization (WHO) estimated that in 2014 there were 422 million patients with diabetes (mainly type 2) worldwide. Type 2 diabetes mellitus is a group of disorders characterized by hyperglycemia and associated with microvascular (optic, renal and neurological) and macrovascular (coronary and peripheral vascular) complications. Approximately 35% of patients with diabetes eventually develop nephropathy and is the leading cause of end stage renal disease. Nearly 30% of chronic renal failures in India are due to diabetic nephropathy. 1
Anemia is a common finding in patients with diabetes and stage of CKD in patients with diabetic nephropathy than in patients without diabetes. Although a number of factors contribute to an increased prevalence of anemia in diabetes, an uncoupling of hemoglobin concentration and renal erythropoietin synthesis associated with tubular dysfunction appears to be the dominant factor. 2 The prominent damage to the cells and vasular architecture of renal interstitum, systemic inflammation, autonomic neuropathy and the induction of inhibitors of erythropoietin release have all been suggested as contributing to anemia in diabetic nephropathy3 .
Conclusion
The functional erythropoietin deficiency and resulting anemia is more common in patients with diabetic nephropathy than diabetic patients without diabetic nephropathy. This may be because of failure of the kidney to produce erythropoietin in response to a falling Hb is a key component of anemia in diabetes. So further researches are suggested whether duartion of DM, poor glycemic control etc in developing diabetic nephropathy and anemia. The anemia of diabetic nephropathy seems to develop in patients with type -2 diabetes before the onset of advanced renal failure and even with relatively normal levels of serum creatinine. It's also a subject to further study.