Erythropoietin depletion and anaemia in diabetes mellitus

Authors: Winkler A.S.; Marsden J.; Chaudhuri K.R.; Hambley H.; Watkins P.J.

Source: Diabetic Medicine, Volume 16, Number 10, October 1999 , pp. 813-819(7)

Publisher: Wiley-Blackwell

Abstract:

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 mol/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.

Keywords: anaemia; autonomic neuropathy; erythropoietin; postural hypotension; Type 1 diabetes mellitus

Language: English

Document Type: Research article

Publication date: 1999-10-01

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• In this Subject: Internal Medicine
• By this author: Winkler A.S. ;  Marsden J. ;  Chaudhuri K.R. ;  Hambley H. ;  Watkins P.J.

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