The anaemia of progressive renal insufficiency is more severe in diabetics

R Gokhale, K Farrington, P Warwicker

Lister Hospital, Stevenage

Problem. Anaemia is a major component of progressive renal insufficiency and there are suggestions that the problem may occur at an earlier stage in patients with diabetes than in their non-diabetic counterparts.

Purpose. We examined this hypothesis in a retrospective cross-sectional study in two cohorts of patients, diabetic and non-diabetic, with varying degrees of renal insufficiency.

Design. We identified 171 diabetic patients with varying degrees of renal insufficiency from computer based records together with the same number of non-diabetic patients matched for age, sex and serum creatinine. Haemoglobin and serum creatinine levels relating to their first clinic visit were recorded.

Findings. Haemoglobin levels were identical in diabetics and non-diabetics in mild (serum creatinine less than 150 umol/), and moderate renal insufficiency (serum creatinine between 150 and 300 umol/l). However in patients with more severe renal impairment (serum creatinine > 300 umol/l) haemoglobin levels were significantly lower in diabetics than in non-diabetics (10.3 ± 1.7 vs 12.4 ± 1.3 g/dl: p <0.001).

Conclusion. Our findings provide support for the notion that patients with diabetes develop more severe anaemia earlier in the course of progressive renal insufficiency than non-diabetics. This has important implications in the management diabetic patients in these circumstances. The reasons for the phenomena are uncertain but possible causes will be discussed.