Anemia, diabetes, and chronic kidney disease

Anemia is common and contributes to both poor QOL and increased risk for adverse outcomes including death. Treatment of anemia improves QOL; however, thus far, evidence is lacking for a benefit of anemia treatment on progression of kidney disease and cardiovascular outcomes. The NKF recommends that physicians consider treating anemia in patients with diabetes and kidney disease when Hb is <11 g/dl in patients. Further, they recommend a Hb target of 11-12 g/dl, not to exceed 13 g/dl, when using an ESA as part of the therapeutic regimen for managing anemia. Currently available ESA combined with iron supplementation can be used safely and effectively to achieve this goal. However, available clinical trial evidence leaves sufficient uncertainty regarding the optimal Hb target and ESA dose for a given individual. For this reason, the NKF recommends individualizing treatment of anemia with ESA. Additional randomized clinical trials are needed to more precisely define these parameters for an individual patient. Future studies are also needed to elaborate the mechanisms of anemia in patients with diabetes and CKD including the role of iron metabolism, inflammation, and resistance.