title: Diabetes mellitus increases the prevalence of anemia in patients with chronic kidney disease: A nested case-control study.
abstract: OBJECTIVE
  To compare anemia prevalence between matched chronic kidney disease (CKD) patients with and without diabetes mellitus (DM) and to assess factors associated with anemia development.
  
  
  METHODS
  This is a nested case-control study of 184 type-2 diabetic and 184 non-diabetic CKD patients from a prospectively assembled database of a Nephrology outpatient clinic, matched for gender, age and estimated glomerular filtration rate (eGFR). Prevalence of anemia (hemoglobin: Men: < 13 g/dL, women: < 12 g/dL and/or use of recombinant erythropoietin) was examined in comparison, in the total population and by CKD Stage. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with anemia.
  
  
  RESULTS
  The total prevalence of anemia was higher in diabetics (47.8% vs 33.2%, P = 0.004). Accordingly, prevalence was higher in diabetics in CKD Stage 3 (53.5% vs 33.1%, P < 0.001) and particularly in Stage 3a (60.4% vs 26.4%, P < 0.001), whereas it was non-significantly higher in Stage 4 (61.3% vs 48.4%; P = 0.307). Serum ferritin was higher in diabetics in total and in CKD stages, while serum iron was similar between groups. In multivariate analyses, DM (OR = 2.206, 95%CI: 1.196-4.069), CKD Stages 3a, 3b, 4 (Stage 4: OR = 12.169, 95%CI: 3.783-39.147) and serum iron (OR = 0.976, 95%CI: 0.968-0.985 per mg/dL increase) were independently associated with anemia.
  
  
  CONCLUSIONS
  Prevalence of anemia progressively increases with advancing stages of CKD and is higher in diabetic than matched non-diabetic CKD patients and diabetes is independently associated with anemia occurrence. Detection and treatment of anemia in diabetic CKD patients should be performed earlier than non-diabetic counterparts.
authors.affiliation: Charalampos Loutradis, Pantelis A Sarafidis, Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Loutradis
authors.affiliation: Charalampos Loutradis, Pantelis A Sarafidis, Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Skodra
authors.affiliation: Charalampos Loutradis, Pantelis A Sarafidis, Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Georgianos
authors.affiliation: Charalampos Loutradis, Pantelis A Sarafidis, Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
authors.forename: Panagiota
authors.initials: P
authors.lastname: Tolika
authors.affiliation: Charalampos Loutradis, Pantelis A Sarafidis, Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Alexandrou
authors.affiliation: Charalampos Loutradis, Pantelis A Sarafidis, Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
authors.forename: Afroditi
authors.initials: A
authors.lastname: Avdelidou
authors.affiliation: Charalampos Loutradis, Pantelis A Sarafidis, Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece.
authors.forename: Pantelis A
authors.initials: PA
authors.lastname: Sarafidis
keywords: Anemia; Chronic kidney disease; Diabetes; Ferritin; Prevalence of anemia