A DGReview of :"Erythropoietin response to hypoxia in patients with diabetic autonomic neuropathy and non-diabetic chronic renal failure"
By James Adams
Type 1 diabetics with early nephropathy and symptomatic autonomic neuropathy can mount an appropriate erythropoietin (EPO) response to moderate hypoxia, despite having EPO-deficient anaemia.
Patients with non-diabetic chronic renal failure, in contrast, mount an EPO response to hypoxia with lower than normal EPO levels.
Investigators from King's College Hospital in London, England, assessed EPO response to hypoxia in hopes of clarifying mechanisms involved in EPO-deficient anaemia. Five type 1 diabetics with EPO-deficient anaemia and early diabetic nephropathy were compared with four patients with non-diabetic advanced chronic renal failure and nine normal controls.
Hourly serum EPO levels were measured during six hours of hypoxia with inspired oxygen levels at 11.6 to 12.6 percent.
Results showed that EPO production increased in all groups after two hours. Diabetic patients with EPO-deficient anaemia reached maximal response at six hours that was similar to that of normal subjects.
Non-diabetic renal failure patients also mounted an EPO response to hypoxia, but at lower EPO levels compared with normal subjects.
Because EPO response was normal in the diabetic subjects, the "mechanism underlying the EPO-deficient anaemia present in some diabetic patients remains unclear," the investigators conclude.
Diabet Med 2002; 19(1): 65-69. "Erythropoietin response to hypoxia in patients with diabetic autonomic neuropathy and non-diabetic chronic renal failure"