Anaemia in diabetic renal disease: an underestimated risk factor.

Abstract

Diabetes is associated with numerous complications that affect many organs in the body, including the kidney. In fact, diabetes mellitus is the most common cause of end-stage renal disease in the Western world. At least 16% of patients undergoing renal replacement therapy in Europe have diabetic nephropathy and the incidence of this is increasing [2]. As part of this end-stage renal disease and part of the diabetes, anaemia arises early, frequently before dialysis is required [3]. We are also well aware that diabetic patients are at particularly high risk of cardiovascular complications [4]. In general, type 2 diabetic patients tend to die of cardiac disease. There is a large number of cardiovascular complications, such as coronary artery disease, stroke and silent myocardial ischaemia, which present as diabetic complications. In addition, cardiovascular complications are more abundant in diabetic patients starting dialysis, and new cardiovascular complications increase while patients are on dialysis. Largely due to this increase in cardiovascular mortality, diabetic patients reaching end-stage renal disease also have a poorer survival on dialysis than non-diabetic patients [5]. What can we therefore do to improve the prognosis for diabetic patients with end-stage renal disease? First and foremost is the early recognition of and intervention on risk factors. It is necessary to control blood glucose and to control the atheromatous lipid pattern that occurs in diabetes, namely low HDL and high triglycerides, leading to changes in the LDL pattern and consequently to the development of atheroma. Since anaemia occurs early in diabetic patients with end-stage renal disease and is associated with an increased incidence of cardiovascular complications, early anaemia management is particularly in these patients. Thus, an early recognition of the condition and a multidisciplinary approach will facilitate and improve the management of these patients, with the aim of reducing these multiple complications.