Family Practice Advance Access originally published online on March 2, 2009
Family Practice 2009 26(3):180-182; doi:10.1093/fampra/cmp009
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Over-representation of diabetic patients with renal anaemia in the primary care setting
a Department of Nephrology, University Hospital of North Staffordshire, Stoke-on-Trent, UK
b Kidsgrove Medical Centre, Kidsgrove, Staffordshire, UK
c Diabetes Care, Heart of Birmingham Teaching Primary Care Trust, Birmingham, UK
Correspondence to Samiul Mostafa, Department of Nephrology, University Hospital of North Staffordshire, Princes Road, Hartshill, Stoke-on-Trent ST4 7LN, UK. Email: samiul_m{at}hotmail.com
Received 1 May 2008; Revised 10 January 2009; Accepted 1 February 2009.
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Abstract |
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Aims. Anaemia is a complication of chronic kidney disease (CKD); the National Institute for Clinical Excellence (NICE) have defined renal anaemia as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 and haemoglobin (HB) <11.0 g/dl. The purpose of this study was to see if diabetic patients have a higher prevalence in primary care of this new anaemia definition. Furthermore, we wished to determine whether diabetic patients were over-represented above HB 11.0 g/dl, which may lead to developing renal anaemia.
Methods. We used an observational prevalence study in primary care from one Staffordshire practice in 2005–2006. Egton Medical Information Systems Ltd computer database was searched for patients with two Modification of Diet in Renal Disease eGFRs separated by 3 months, HB levels and medications.
Results. From a list size of 1830 patients, 362 had two eGFRs <60; of those, 308 had a HB available. In all, 29 (9.4%) patients had NICE renal anaemia, with over-representation of diabetic patients, 13 (16%) against 16 (7%) without diabetes (P < 0.02). We found that diabetic patients were also over-represented at HB 11.0 to <12.5 g/dl, 26 (32%) with diabetes and 39 (17.6%) without (P < 0.001). Mean HB was significantly lower for the diabetic group (n = 81, 26%), 12.8 g/dl (95% Confidence Intervals (CI) 12.4–13.1) against non-diabetic group (n = 227, 74%), 13.4 g/dl (95% CI 13.2–13.6), P < 0.01. Predictors of HB on multivariate regression analysis were female gender, eGFR and diabetes (all P < 0.001).
Conclusions. Diabetic patients were more likely to have NICE defined renal anaemia in this primary care population with CKD stages 3–5. This is similar to observations in secondary care settings. We observed over-representation of diabetic patients above NICE definition at HB 11.0 to <12.5 g/dl.
Keywords. Diabetes, primary care, renal anaemia.
Mostafa S, Tagboto S, Robinson M, Burden A and Davies S. Over-representation of diabetic patients with renal anaemia in the primary care setting. Family Practice 2009; 26: 180–182.