Endocrine Abstracts

Anemia occurs early and predicts high risk of cardiovascular events and death in patients with diabetic nephropathy (DN). It results from various factors including erythropoietin (EPO) deficiency and inflammation. The aim of this study was to evaluate clinical correlates of TNF alpha levels in anemic patients with early diabetic nephropathy. We investigated 95 anemic patients with type 2 diabetes mellitus and chronic kidney disease (stages 1–3). Glomerular filtration rate was calculated by Cockcroft-Gault formula. Anemia was defined according to World Health Organization criteria (2008). In addition to routine clinical tests we measured serum levels of EPO and TNF alpha using immunoassay. Correlations were assessed by Spearmen’s correlation coefficient (rs). We found EPO deficiency in 46.3% and decreased serum ferritin levels in 11.6% patients. Serum level of TNF alpha correlated negatively with hemoglobin level (rs=−0.311, P=0.003). It had no significant interrelations with age, serum creatinine, ferritin, cholesterol, glomerular filtration rate and urinary albumin excretion. In patients without EPO deficiency TNF alpha level correlated with mean cell hemoglobin content (rs=−0.700, P=0.003), serum EPO (rs=0.375, P=0.017) and urea concentrations (rs=0.433, P=0.011). In EPO-deficient patients it correlated with serum urea (rs=0.393, P=0.032) but not with mean cell hemoglobin content (P=0.950) and EPO level (P=0.247). The results of the study suggest that anemia in patients with early DN is multifactorial. EPO-deficient and EPO-sufficient anemic patients with DN are characterized by different clinical correlates of serum TNF alpha level. Further larger studies are needed to elucidate clinical implications of these findings.