[Influence of metabolic control on hemoglobin level in type 1 diabetic patients with nephropathy].
OBJECTIVE
Diabetic patients with nephropathy show a decline of hemoglobin even at a moderate degree of kidney dysfunction which may impair cardiovascular prognosis. As main reason a disturbed synthesis of erythropoietin (EPO) has been suggested, the pathogenesis, however, is unclear. The clinical significance of metabolic control for the hemoglobin and EPO levels was investigated.


METHODS
The following parameters were determined in 185 type 1 diabetic patients: hemoglobin, HbA1c, calculated creatinine clearance, urinary albumin/creatinine ratio, lipids, high-sensitive C-reactive protein (hsCRP). Serum concentration of EPO was determined in 56 consecutive patients with renal dysfunction.


RESULTS
Hemoglobin concentration decreased with declining renal function. Patients were stratified according to median HbA1c level (7.4%) in those with better (HbA1c < 7.4%) and worse metabolic control (HbA1c > 7.4%). In patients with kidney dysfunction, the group with better metabolic control showed higher hemoglobin concentrations than the group with worse metabolic control: 13.6 versus 12.6 g/dl at creatinine clearance < 60 ml/min (p = 0.02). Linear regression analysis revealed metabolic control aside from kidney function, gender, hsCRP and use of ACE inhibitiors as a significant influencing factor of hemoglobin concentration. In patients with renal dysfunction, EPO levels were higher in the group with better than worse metabolic control (13.0 vs. 9.8 U/l).


CONCLUSIONS
The decline of hemoglobin in diabetic patients with renal dysfunction is mitigated in case of good metabolic control, possibly due to higher EPO concentrations. The results emphasize the clinical significance of a good metabolic control in diabetic patients with nephropathy.
Raupp
Dorothea
D
Abteilung für Innere Medizin, St. Josefskrankenhaus Heidelberg, Akademisches Lehrkrankenhaus der Universität Heidelberg, Heidelberg.
Vogt
Cornelia
C
Dreyhaupt
Jens
J
Hasslacher
Christoph
C
D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D004921:Erythropoietin / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D014280:Triglycerides / Q000097:blood
D000806:Angiotensin-Converting Enzyme Inhibitors; D002784:Cholesterol; D004921:Erythropoietin; D006442:Glycated Hemoglobin; D014280:Triglycerides