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Over-representation of diabetic patients with renal anaemia in the primary care setting

Samiul Mostafa1, Senyo Tagboto, Michael Robinson

  • 1Department of Nephrology, University Hospital of North Staffordshire, Princes Road, Hartshill, Stoke-on-Trent ST4 7LN, UK. samiul_m@hotmail.com

Family Practice
|March 4, 2009
PubMed

Insights

Diabetic patients with chronic kidney disease (CKD) have a higher prevalence of renal anaemia. This study found that diabetes is a predictor of renal anaemia, even in patients with haemoglobin levels above the NICE definition.

Area of Science:

  • Nephrology
  • Endocrinology
  • Primary Care Medicine

Background:

  • Anaemia is a common complication of chronic kidney disease (CKD).
  • The National Institute for Clinical Excellence (NICE) defines renal anaemia using estimated glomerular filtration rate (eGFR) and haemoglobin (HB) levels.
  • Diabetic patients may have a higher risk of developing renal anaemia.

Purpose of the Study:

  • To determine the prevalence of NICE-defined renal anaemia in diabetic patients within a primary care setting.
  • To investigate whether diabetic patients are over-represented in the group with haemoglobin levels above the NICE definition threshold.
  • To identify predictors of haemoglobin levels in patients with CKD.

Main Methods:

  • An observational prevalence study was conducted in a single primary care practice.
  • Data from 2005-2006 were extracted from the Egton Medical Information Systems Ltd computer database.
  • Patients with at least two eGFR measurements (Modification of Diet in Renal Disease) separated by 3 months, HB levels, and medication data were included.

Main Results:

  • Of 362 patients with eGFR <60 ml/min/1.73 m2, 29 (9.4%) had NICE-defined renal anaemia.
  • Diabetic patients showed a higher prevalence of NICE-defined renal anaemia (16% vs. 7%, P < 0.02).
  • Diabetic patients were also over-represented at HB levels of 11.0 to <12.5 g/dl (32% vs. 17.6%, P < 0.001), with a significantly lower mean HB (12.8 g/dl vs. 13.4 g/dl, P < 0.01).
  • Female gender, eGFR, and diabetes were significant predictors of HB levels (all P < 0.001).

Conclusions:

  • Diabetic patients with CKD stages 3-5 are more likely to have NICE-defined renal anaemia in primary care.
  • This finding is consistent with observations in secondary care.
  • Diabetic patients are over-represented even at haemoglobin levels above the NICE definition threshold, suggesting a need for closer monitoring.
Abstract

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