Erythropoietin response to anemia and its association with autonomic neuropathy in type 2 diabetic patients without advanced renal failure

Kim, Mee Kyoung; Baek, Ki Hyun; Lim, Dong Jun; Kim, Young Kyu; Kang, Moo-Il; Lee, Kwang-Woo; Song, Ki-Ho

doi:10.1016/j.jdiacomp.2009.02.002

« Previous Next »Journal of Diabetes and Its Complications
Volume 24, Issue 2 , Pages 90-95, March 2010

Erythropoietin response to anemia and its association with autonomic neuropathy in type 2 diabetic patients without advanced renal failure

Mee Kyoung Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
- These authors equally contributed to this work.
Ki Hyun Baek
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
- These authors equally contributed to this work.
Dong Jun Lim
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
Young Kyu Kim
- Department of Preventive Medicine, The Catholic University of Korea, Seoul, Korea
Moo-Il Kang
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
Kwang-Woo Lee
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
Ki-Ho Song
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
- Corresponding author. Department of Internal Medicine, St. Mary's Hospital, The Catholic University of Korea, 62 Yoido-dong Youngdeungpo-gu, Seoul 150-713, Korea. Tel.: +82 2 3779 1557; fax: +82 2 780 3132.

Received 10 December 2008; accepted 4 February 2009. published online 23 March 2009.

Abstract

Aim

We aim to investigate erythropoietin (EPO) response to anemia and its association with autonomic neuropathy in type 2 diabetic patients without advanced renal failure.

Methods

A cross-sectional study was conducted on 211 type 2 diabetes mellitus patients without advanced renal failure [estimated glomerular filtration rate (eGFR) >40 ml/min/1.73 m²]. The response of EPO to anemia of type 2 diabetic patients without advanced renal failure was compared with those of nondiabetic control subjects. Autonomic nerve function was assessed using three cardiovascular tests (deep breathing, the Valsalva maneuver, and lying-to-standing). The results of each test were scored as 0 if normal, 1 if borderline, and 2 if abnormal. Autonomic neuropathy was diagnosed when a total score of the tests was 2 or more.

Results

Fifty-eight patients were anemic; compared with nonanemic patients, they had a longer duration of diabetes (16.69±10.11 vs. 10.67±8.41 years, P<.001), lower eGFR (66.43±16.30 vs. 81.74±19.49 ml/min/1.73 m², P<.001), and higher cardiovascular autonomic neuropathy score (3.17±1.95 vs. 1.79±1.72, P<.001). Serum EPO level was weakly correlated with hemoglobin (Hb) level (r=−.085, P<.001). However, the slopes of regression lines between EPO and Hb levels differed significantly between type 2 diabetic patients and nondiabetic control subjects (−0.0085 vs. −0.255, P=.008). Multiple linear regression analysis revealed that cardiovascular autonomic neuropathy score was independently related to Hb (P<.001) or EPO level (P=.052).