Anemia Risk Factors in Diabetic Nephropathy Patients Identified

NEW ORLEANS—Malnutrition and abnormal calcium-phosphate metabolism are risk factors for for anemia for patients with diabetic nephropathy (DN), according to new study findings presented at the American Society of Nephrology’s Kidney Week 2017 meeting.

Anemia developed in 72 of 156 patients with DN from type 2 diabetes not on dialysis, Andreea Andronesi, MD, of Fundeni Clinical Institute in Bucharest, Romania, and colleagues reported. The mean hemoglobin (Hb) level in anemic patients was 10.5 g/dL: 39.3% had mild anemia (Hb above 11 g/dL), 57.1% had moderate anemia (8 to 11 g/dL), and 3.6% had severe anemia (below 8 g/dL). Although anemia prevalence rose with advancing chronic kidney disease (CKD) stage, even those with mild stage 2 CKD had low levels of Hb. Those with a longer history of DN were more likely to develop anemia.

In a case-control comparison of the 72 anemic and 84 non-anemic patients, Dr Andronesi’s team found that anemia correlated with malnutrition and abnormal calcium-phosphate metabolism. Patients with anemia had significantly lower body mass index (27.4 vs 30.4 kg/m²) and albuminemia (3.4 vs 4.1 g/dL). Higher Hb values, in contrast, were strongly linked with greater albuminemia and higher estimated glomerular filtration rate. Abnormal proteinuria was associated with a significant 3-fold increased odds of anemia.

Lower Hb was associated with abnormal calcium-phosphate metabolism. Anemic patients had significantly higher serum phosphorus (4.7 vs 3.8 mg/dL) and serum intact parathyroid hormone (81.2 vs 64.9 pg/dL) and lower calcemia (9.2 vs 9.5 mg/dL).

In adjusted logistic regression analyses, the investigators also identified proteinuria and use of renin-angiotensin-aldosterone system blockers as independent risk factors for anemia. Both factors were associated with a significant 6-fold increased odds for anemia.

Guidelines by both the American Diabetes Association and Kidney Disease: Improving Global Outcomes (KDIGO) do not recommend screening for anemia in patients with glomerular filtration ratio higher than 60 mL/min/1.73m², Dr Andronesi told to Renal & Urology News. “Nevertheless, because anemia is present in diabetic patients in early stages of chronic kidney disease, anemia screening is important when diabetic kidney disease is diagnosed.”

The team is planning future research on possible factors, such as obesity, influencing anemia development in DN patients.

Reference

Andronesi A. Risk factors for anemia in diabetic kidney disease. Data presented in poster format at Kidney Week 2017 in New Orleans (Oct. 31-Nov. 5). Poster TH-PO742.