Erythropoitin level in diabetics with and without autonomic neuropathy: relation to anaemia and metabolic control

ABSTRACT

Anaemia is a frequently noted complication of diabetes. There are several causes for anaemia in diabetes, however, in some diabetic anaemic patients the cause of their anaemia was not clearly explained despite differential hematological studies. This study aimed to measure the level of erythropoietin [EPO] in diabetic anaemic patients with and without autonomic neuropathy, and to compare this level with non-diabetic anaemic patients as control. We therefore studied the clinical and biochemical characteristics of 40 diabetic patients with anaemia of uncertain cause and patients were subdivided into two groups those complicated with autonomic neuropathy [Group I, n=20], and those without autonomic neuropathy [Group II, n=20]. In addition, we enrolled 20 non-diabetic patients with similar degree of anaemia [Group Ill, n=20] in order to compare the serum EPO responsiveness to anaemia. The haemoglobin levels of diabetic patients correlated with creatinine clearance [r=0.34, p=0.009], but showed no relation to age, sex, duration of diabetes, or glycosylated haemoglobin percentage. The serum EPO concentrations of Group I patients [11.41 +/- 2.58 mIU/ml] were significantly lower than those of Group II[29.92 +/- 6.27 mIU/ml], and Group Ill [38.66 +/- 12.90 mIU/mI]. We concluded that the relatively low serum EPO levels of Group I patients could be the cause of their anaemia, and that the autonomic neuropathy complicating this group of diabetic anaemia patients could be the cause of this blunted EPO responsiveness to anaemia