Over-representation of diabetic patients with renal anaemia in the primary care setting

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 m(2) 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.