Anaemia--a diabetologist's dilemma?

Anaemia occurs earlier and is more severe in diabetic patients with end-stage renal disease (ESRD) than in non-diabetic ESRD patients controlled for the same level of renal function. In contrast to non-diabetic patients, diabetic ESRD patients demonstrate an impaired physiological response to anaemia; endogenous serum erythropoietin levels are low in relation to the level of anaemia. The reasons for the anaemia are probably a combination of tubulointerstitial damage and autonomic neuropathy. The use of angiotensin-converting enzyme inhibitors, which has been reported to be associated with an inhibition of erythropoiesis, does not seem to have a clinically significant effect on haemoglobin levels. In order to address all the independent risk factors in diabetic ESRD, optimal management of these patients should involve interdisciplinary care (diabetologist and nephrologist) and consideration of correction of anaemia.