Endocrine Abstracts

Aims: Anaemia occurs early and predicts high risk of cardiovascular events and death in patients with diabetic nephropathy. In our previous studies we have shown that haemoglobin level has a negative correlation with serum levels of proinflammatory cytokines in this clinical group. It could be hypothesised that treatment of anaemia has anti-inflammatory effects. The aim of this study was to assess the influence of treatment with erythropoietin alpha on serum level of tumour necrosis factor alpha (TNFα) in patients with early diabetic nephropathy.

Methods: We included 36 patients with type 2 diabetes mellitus and early diabetic nephropathy (CKD stages 1–3) complicated with anaemia. Patients with non-renal causes of anaemia and/or iron overload were not included. The main group (17 patients) received erythropoietin alpha subcutaneously (starting from 30 IU/kg with further correction of dose according to NKF-K/DOQI Guidelines, 2006) and iron medication orally (ferrous sulphate, 200 mg/day) for 16 weeks. The control group (19 patients) received only oral iron medication (ferrous sulphate, 200 mg/day) for the same period of time. Besides performing routine clinical tests we measured serum concentrations of TNFα using EIA before and after 16 weeks of treatment. Mann–Whitney U test was used to compare mean levels of TNFα in study groups. Wilcoxon’s test was used to assess dynamics of this parameter during treatment in each group.

Results: Before treatment we found no difference in mean serum levels of TNFα in clinical groups: main group – 30.8±4.5 pg/ml, control group – 27.5±3.9 pg/ml (reference value <50 pg/ml). After 16 weeks of treatment both groups had no significant changes in concentrations of TNFα as compared to initial values. Mean serum levels of TNFα were as follows: main group – 25.0±3.6 pg/ml, control group – 31.1±4.2 pg/ml (P>0.05 for the difference between studied groups).

Conclusion: The results of the study suggest that neither treatment with iron sulphate nor comprehensive antianaemic therapy with erythropoietin alpha and iron medication don’t lead to a reduction in serum concentration of TNFα in anaemic patients with early stages of diabetic nephropathy.