Anaemia in diabetes patients with or without CKD tied to significant risk of death

There is a high prevalence of diabetes in the US, impacting about 11% of the adult population. Much focus has been placed on end-organ damage and major CVD (cardiovascular disease) events as diabetes complications. Still, it is also vital to understand comorbid conditions such as anaemia and their role in long-term prognosis. Anaemia affects about 8% and 18% of diabetic patients and increases the risk of complications such as diabetic foot ulcers, heart failure, and diabetic retinopathy.

Through multiple pathophysiological mechanisms, hyperglycemia significantly contributes to CKD onset and progression, itself a known risk factor for anaemia, increased mortality, and CVD comorbidity. Increased levels of circulating inflammatory cytokines in the hyperglycemic state can result in anaemia. Therefore, anaemia and chronic kidney disease may be significant markers of diabetes outcomes owing to their unique etiologies among adults with diabetes.

Against the above background, Alain K. Koyama, Centers for Disease Control and Prevention, Atlanta, and colleagues aimed to evaluate anaemia prevalence by CKD status and the role of anaemia and CKD as potential risk factors for all-cause mortality among adults with diabetes in the United States.

For this purpose, the researchers designed a retrospective cohort study including 6,718 adult participants with prevalent diabetes from the NHANES (National Health and Nutrition Examination Survey). The role of anaemia, alone or combined, was evaluated by Cox regression models as predictors of all-cause mortality.

The authors reported the following findings:

• Anaemia prevalence among adults with diabetes and CKD was 20%.
• Compared with having neither condition, anaemia or CKD alone was remarkably associated with all-cause mortality (anaemia: HR=2.10, CKD: HR=2.24).
• Having both conditions conferred a greater potential risk (HR=3.41).

About one-quarter of the adult US population with diabetes and chronic kidney disease also have anaemia. "Anaemia presence, with or without CKD, is linked with a two- to threefold increased death risk compared with adults having neither condition, suggesting that anaemia may be a strong predictor of death among diabetics patients," the researchers conclude.

Reference:

Koyama, A. K., Lundeen, E., McKeever Bullard, K., & Pavkov, M. E. (2023). Prevalence of Anemia and Associated All-Cause Mortality Among Adults With Diabetes: The Role of Chronic Kidney Disease. Diabetes Research and Clinical Practice, 110695. https://doi.org/10.1016/j.diabres.2023.110695