Nada Dimković1. 1. Centar za bubrezne bolesti i metabolicke poremećaje Prof. dr Vasilije Jovanović, Beograd. dim@eunet.yu
Abstract
INTRODUCTION: Anemia is more common and pronounced in patients with diabetic, than in patients with non-diabetic renal disease. While several factors contribute to its pathogenesis, the failure of the kidney to increase erythropoietin in response to falling hemoglobin appears to be the dominant factor. The most frequent complications of anemia in diabetic patients include decreased quality of life and work capacity and increased cardiovascular morbidity and mortality. MATERIAL AND METHODS: This cross-sectional multicenter study included a total of 539 patients with type I (approximately 20%) and type II diabetes (approximately 80%) classified into five stages according to the glomerular filtration rate. RESULTS: Diabetic nephropathy appears in stage I, and progresses in all patients to the stage V (p = 0.045). The presence of anaemia progressively increased from stage I to stage V (from 60% to 100%, p = 0.008). Only 62% of patients with anemia were treated (mainly with iron) and only 3.4% received erythropoietin treatment. Hypertension was present in 90% of patients in stage I and in 100% of patients in stage V nephropathy. The presence of heart failure increased Jiom 0% (stage I) to 51% (stage IV, p = 0.03). Around 62% of patients were referred to a nephrologist, and according to the logistic regression model, renal failure and presence of anaemia were significant predictors of patients' referral to nephrologist. CONCLUSION: In a primary care setting, anemia is a frequent finding, even in the very beginning of diabetic renal disease. Currently available guidelines for management of anemia are not followed; this may explain high percentage of patients with heart failure in pre-dialysis stage. Early referral to a nephrologist and regular follow-up by an endocrinologist and cardiologist are the best way for the prevention of diabetic complications and comorbidity.
INTRODUCTION:Anemia is more common and pronounced in patients with diabetic, than in patients with non-diabetic renal disease. While several factors contribute to its pathogenesis, the failure of the kidney to increase erythropoietin in response to falling hemoglobin appears to be the dominant factor. The most frequent complications of anemia in diabeticpatients include decreased quality of life and work capacity and increased cardiovascular morbidity and mortality. MATERIAL AND METHODS: This cross-sectional multicenter study included a total of 539 patients with type I (approximately 20%) and type II diabetes (approximately 80%) classified into five stages according to the glomerular filtration rate. RESULTS:Diabetic nephropathy appears in stage I, and progresses in all patients to the stage V (p = 0.045). The presence of anaemia progressively increased from stage I to stage V (from 60% to 100%, p = 0.008). Only 62% of patients with anemia were treated (mainly with iron) and only 3.4% received erythropoietin treatment. Hypertension was present in 90% of patients in stage I and in 100% of patients in stage V nephropathy. The presence of heart failure increased Jiom 0% (stage I) to 51% (stage IV, p = 0.03). Around 62% of patients were referred to a nephrologist, and according to the logistic regression model, renal failure and presence of anaemia were significant predictors of patients' referral to nephrologist. CONCLUSION: In a primary care setting, anemia is a frequent finding, even in the very beginning of diabetic renal disease. Currently available guidelines for management of anemia are not followed; this may explain high percentage of patients with heart failure in pre-dialysis stage. Early referral to a nephrologist and regular follow-up by an endocrinologist and cardiologist are the best way for the prevention of diabetic complications and comorbidity.