Iron deficiency in chronic kidney disease patients with diabetes mellitus

Backgrounds: Iron deficiency has been studied extensively in patients with chronic kidney disease on hemodialysis therapy. However, few studies looked at iron treatment in the non-dialysis chronic kidney disease population.

Methods: Five hundred and eighty patients were studied (247 were diabetic persons). Patients were divided into 4 groups: non-diabetic subjects without CKD, non-diabetic ones with GFR < 60 mL/min, diabetic persons without CKD and diabetic ones with GFR < 60 mL/min). Iron deficiency was diagnosed when serum ferritin level was <100 mg/dl. It was defined as diminished iron availability when ferritin was above 100 mg/dl and serum transferrin saturation (TSAT) was <20%.

Results: Anemia was more frequent in the diabetic CKD patients group (52.4%, p < 0.001). Anemia prevalence was also higher in all CKD patients as well as in diabetic patients compared with non-diabetic ones. Iron deficiency was more frequent in diabetic patients. Among CKD diabetic patients the prevalence of iron deficiency was higher than in non-diabetic CKD ones. Diminished iron availability prevalence was higher in non-diabetic patients. Logistic regression analysis showed that only sex and diabetes mellitus were independently associated with iron deficiency.

Conclusions: Anemia was more common in diabetic CKD patients. Diabetes mellitus was independently associated with iron deficiency. Surprisingly, diminished iron availability was not more frequent in diabetic patients. The physio-pathological mechanisms that could explain these findings remain to be elucidated.