Anaemia may be under-recognized in patients with diabetes, kidney disease
Anaemia appears to be prevalent in patients with concurrent type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD), although the majority of cases are undiagnosed, a study reports. Inadequate treatment of the blood disorder is also common.
The cross-sectional study included 808 adult patients (mean age 60.5 years; 56.2 percent male) with T2DM (median duration, 7 years) and CKD (median duration, 2 years) who were recruited from primary care clinics in Malaysia. Researchers performed blood testing, and anaemia was confirmed when haemoglobin (Hb) levels were <13.0 g/dL in men and <12.0 g/dL in women.
A total of 256 patients had anaemia, with a prevalence of 31.7 percent. The blood disorder was mostly mild (61.5 percent) and normocytic normochromic (58.7 percent).
Notably, the majority (88.7 percent) of patients with anaemia were not known to have such prior to the study. Of the 36 patients with documented history of anaemia, 80.6 percent were still anaemic, and only half received iron therapy.
Multivariate regression analysis showed that anaemia was likely to be present in the following patient subgroups: women (adjusted odd ratio [AOR], 1.57; 95 percent CI, 1.12–2.21; p=0.009), older patients (AOR, 1.04; 1.01–1.06; p<0.001), those with moderate-to-end stage CKD (stage 3a: AOR, 2.47; 1.25–4.87; p=0.009; stage 3b: AOR, 4.36; 2.14–8.85; p<0.001; stage 4: AOR, 10.12; 4.36–23.47; p<0.001; stage 5: AOR, 10.80; 3.32–35.11; p<0.001) and those with foot complication (AOR, 3.12; 1.51–6.46; p=0.002).
Factors associated with a lower likelihood of anaemia included greater body mass index (BMI; AOR, 0.95; 0.92–0.99; p=0.012) and higher diastolic blood pressure (DBP; AOR, 0.97; 0.95–0.99; p<0.001).
The present data highlight the importance of incorporating anaemia screening into the routine yearly assessment of patients with T2DM and CKD, especially older and female patients, as well as those with CKD stage ≥3, foot complication, lower BMI and lower DBP, researchers said. Screening should facilitate early treatment and hence improve the overall care of this population.