title: Blunted erythropoietin response to anemia in patients with Type 1 diabetes.
abstract: BACKGROUND
  It is known that patients with renal failure have normochromic normocytic anemia due to impaired endogenous erythropoietin (EPO) synthesis. The aim of this work was to determine whether low serum erythropoietin (s-EPO) levels play a role in the pathogenesis of anemia in patients with Type 1 diabetes without overt nephropathy.
  
  
  METHODS
  We included in the study 13 patients with Type 1 diabetes whose Hb levels were <11 g/dl. Blood cell count, s-EPO, urinary albumin excretion rate (AER), HbA(1c), glomerular filtration rate, serum iron, serum ferritin, the presence of neuropathy, retinopathy and nephropathy were determined.
  
  
  RESULTS
  Ten out of 13 patients with anemia (77%) had a blunted EPO response to anemia. All ten patients with low EPO levels had autonomic neuropathy; five had clinical nephropathy but with serum creatinine<1.6 mg/dl. Three patients were treated with rHuEPO and showed an improvement in their anemia after treatment.
  
  
  CONCLUSIONS
  The majority of patients with Type 1 diabetes who had anemia also had low EPO levels. The pathogenesis of this phenomenon is probably multifactorial. Autonomic neuropathy appears to play a role, but it is not sufficient, per se, to be the only cause. Dysautonomia might enhance the effect of renal damage.
authors.affiliation: Institute of Internal Medicine and Geriatrics, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Cotroneo
authors.forename: B
authors.initials: B
authors.lastname: Maria Ricerca
authors.forename: L
authors.initials: L
authors.lastname: Todaro
authors.forename: D
authors.initials: D
authors.lastname: Pitocco
authors.forename: A
authors.initials: A
authors.lastname: Manto
authors.forename: V
authors.initials: V
authors.lastname: Ruotolo
authors.forename: S
authors.initials: S
authors.lastname: Storti
authors.forename: P
authors.initials: P
authors.lastname: Damiani
authors.forename: S
authors.initials: S
authors.lastname: Caputo
authors.forename: G
authors.initials: G
authors.lastname: Ghirlanda
mesh_terms: D000328:Adult; D000740:Anemia / Q000097:blood* / Q000209:etiology*; D003404:Creatinine / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications*; D003928:Diabetic Nephropathies / Q000097:blood / Q000150:complications; D003929:Diabetic Neuropathies / Q000097:blood / Q000150:complications; D004921:Erythropoietin / Q000097:blood*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D006454:Hemoglobins; D004921:Erythropoietin; D003404:Creatinine