Erythropoietin response to anemia and its association with autonomic neuropathy in type 2 diabetic patients without advanced renal failure
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).
Conclusions
Autonomic neuropathy is associated with a blunted EPO response to anemia in type 2 diabetic patients without advanced renal failure.
aDepartment of Internal Medicine, The Catholic University of Korea, Seoul, Korea
bDepartment of Preventive 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.
ABSTRACT