Early erythropoietin deficiency in diabetic kidney lesion


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Abstract

Aim. To evaluate the renal production of erythropoietin (EPO) in relation to filtration function in patients with diabetic kidney lesion. Subjects and methods. The investigation enrolled 183 patients with types 1 and 2 diabetes mellitus (DM), of whom 128 were diagnosed as having diabetic kidney lesion. Serum EPO levels were measured by enzyme immunoassay. Patients who had a glomerular filtration rate (GFR) of below 15 ml/min/1.73 m2 and received erythropoiesis-stimulating agents were excluded from the investigation. Results. The mean serum EPO levels in the patients with diabetic kidney lesion did not vary with the presence of absence of anemia, the degree of albuminuria, or GFR. A physiological inverse relationship was found between the level of EPO and that of hemoglobin in the blood of the patients with DM without kidney disease and in those with renal lesion and GFR ≥60 ml/min/1.73 m2. The magnitude of the association of the values increased as GFR was higher. The level of EPO was found to be unassociated with hemoglobin in patients with GFR <60 ml/min/1.73 m2. Conclusion. In the patients with diabetic kidney lesion, serum EPO concentrations did not depend on the stage of chronic kidney disease and the degree of albuminuria in spite of more severe anemia as renal failure progressed. These patients showed inadequate EPO production just in early diminished renal filtration function.

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Ранний дефицит эритропоэтина при диабетическом поражении почек. - Резюме. Цель исследования. Оценка продукции эритропоэтина (ЭПО) почками в зависимости от фильтрационной функции у больных с диабетическим поражением почек. Материалы и методы. В исследование включили 183 больных сахарным диабетом (СД) 1-го и 2-го типа, из которых у 128 диагностировано диабетическое поражение почек. Уровень ЭПО в сыворотке определяли методом иммуноферментного анализа. Пациентов со скоростью клубочковой фильтрации (СКФ) менее 15 мл/мин/1,73 м2 и получающих средства, стимулирующие эритропоэз, в исследование не включали. Результаты. Средние уровни ЭПО в сыворотке у больных с диабетическим поражением почек не различались в зависимости от наличия либо отсутствия анемии, выраженности альбуминурии и СКФ. Физиологическая обратная связь между уровнем ЭПО и гемоглобина в крови выявлена у больных СД без патологии почек и у пациентов с поражением почек при СКФ ≥60 мл/мин/1,73 м2. Сила ассоциации показателей увеличивалась по мере повышения СКФ. У больных с СКФ <60 мл/мин/1,73 м2 связи уровня ЭПО и гемоглобина не выявлено. Заключение. Концентрация ЭПО в сыворотке у больных с диабетическим поражением почек не зависела от стадии хронической болезни почек, выраженности альбуминурии, несмотря на усиление тяжести анемии по мере прогрессирования почечной недостаточности. У больных с диабетическим поражением почек неадекватная продукция ЭПО наблюдается уже при начальном снижении фильтрационной функции почек.
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