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Nephrol Dial Transplant (2002) 17: 67-72
© 2002 European Renal Association-European Dialysis and Transplant Association


How should we manage anaemia in patients with diabetes?

Ralf Dikow, Vedat Schwenger, Michael Schömig and Eberhard Ritz

Department of Nephrology, University of Heidelberg, Germany

Abstract

Anaemia is an important component of diabetic nephropathy but only recently has it attracted the attention of diabetologists and nephrologists. In diabetic patients, anaemia is the result of diminished erythropoietin production and, to a lesser degree, of increased excretion of erythropoietin in the urine, whereas erythropoietin responsiveness remains unchanged. Although erythropoietin concentrations are predictive of the rate of progression of renal disease, epidemiological studies have failed to show lower haemoglobin concentrations in patients with diabetic compared with non-diabetic renal disease with impaired renal function. However, inappropriately low erythropoietin concentrations and anaemia have been reported in subcohorts of diabetic patients. Further studies are required to determine whether reversal of anaemia has beneficial effects on microvascular and macrovascular diabetic complications, particularly cardiac disease, retinopathy and peripheral arterial disease.

Keywords: anaemia; cardiac disease; chronic kidney disease; diabetes mellitus; epoetin; erythropoietin; haemoglobin

Notes

Correspondence and offprint requests to: Dr Eberhard Ritz, Department of Nephrology, University of Heidelberg, Bergheimer Str. 58, D-69115 Heidelberg, Germany. Tel: +49 6221/91120, fax: +49 6221/162476. e-mail: Prof.E.Ritz{at}T\|[hyphen]\|online.de


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