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Erythropoietin depletion and anaemia in diabetes mellitus
Author(s) -
Winkler A. S.,
Marsden J.,
Chaudhuri K. R.,
Hambley H.,
Watkins P. J.
Publication year - 1999
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.1464-5491.1999.00172.x
Subject(s) - medicine , erythropoietin , microalbuminuria , proteinuria , diabetes mellitus , nephropathy , diabetic nephropathy , endocrinology , gastroenterology , peripheral neuropathy , creatinine , type 2 diabetes mellitus , anemia , albuminuria , kidney
Summary Aims To discover whether Type 1 diabetic patients with autonomic neuropathy might be anaemic and erythropoietin (EPO)‐depleted. Methods Fifteen Type 1 diabetic patients with serious complications (DM‐COMP) were selected because of severe symptomatic autonomic neuropathy, including significant postural hypotension. All had proteinuria from nephropathy (three microalbuminuria and 12 macroalbuminuria), but a normal serum creatinine (< 122 μmol/l). They were compared to age and duration matched Type 1 diabetic controls without autonomic neuropathy (DM‐controls) and non‐diabetic patients with and without hypochromic, microcytic anaemia. Results The DM‐COMP patients were anaemic (mean haemoglobin (Hb) 11.1 ± 1.2 g/dl), sometimes severely (minimum Hb 9.2 g/dl), compared to non‐neuropathic DM‐controls (Hb 13.7 ± 0.7 g/dl; P < 0.001). Furthermore, EPO failed to increase in association with anaemia in the DM‐COMP group compared to the progressive increase in the non‐diabetic, anaemic patients (difference of regression lines P < 0.001), indicating EPO depletion in the anaemic, diabetic patients. There was no other demonstrable cause for the anaemia. Treatment with EPO in 5 DM‐COMP patients led to a rapid increase in haemoglobin (range 1.7–5.0 g/dl) with improvement in wellbeing. Conclusion Some Type 1 diabetic patients with autonomic neuropathy present with an EPO‐depleted anaemia, which responds to treatment with EPO. This observation supports the concept of autonomic neuropathy as a cause of anaemia with EPO depletion, although the role of established renal damage cannot be excluded.