The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

IGF-1 is an Independent Risk Factor for Anemia in Diabetic Pre-dialysis Patients

Kim, Do-Hyoung;Kim, Tae-Young;Kim, Sun-Min;Yoo, Soo-Jeong;Oh, Dong-Jin;Yu, Suk-Hee

  • Published : 20070900
⟨ Previous Next ⟩

Abstract

Background : We investigated whether the presence of diabetes mellitus (DM) was related to the degree of the anemia in predialytic patients with renal failure and what was the most relevant factor for anemia in patients with chronic kidney disease (CKD) from DM (DM-CKD). Methods : Seventy seven patients (47 predialytic patients with long-term type 2 DM (DM-CKD) and 30 predialytic patients whose disease was due to other causes (non DM-CKD)) were enrolled in this study. The blood hemoglobin (Hb) and hematocrit, and the creatinine, ferritin, vitamin B12, folate, iron, LDH, albumin, hs-CRP, intact-PTH, erythropoietin, leptin and Insulin-like growth factor I (IGF-1) levels were measured using standard methods. The estimated GFR was calculated using the abbreviated MDRD equation. Results : The two groups did not significantly differ as to age, gender, the serum creatinine level and the inflammatory status. The Hb level was significantly lower in the DM-CKD patients than that in the non DM-CKD patients (8.5±1.7 g/dL vs 9.6±1.6 g/dL, respectively, p=0.01). The Hb level was significantly lower in the DM-CKD patients who were being treated with ACE inhibitors (the DM-ACE patients) than that in the non DM-CKD patients who were being treated with ACE inhibitors (the non DM-ACE patients) (8.5±1.5 g/dL vs 10.8±1.6 g/dL, respectively, p=0.001). Multiple regression analysis indicated that serum IGF-1 concentration was independently associated with the Hb level (β=0.425, p=0.02) in the DM-CKD patients. Conclusions : The Hb concentration was significantly lower in the DM-CKD patients than that in the non DM-CKD patients. It was independently associated with the serum IGF-1 concentration in the DM-CKD patients.

Keywords

References

  1. Foley RN, Culleton BF, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. Cardiac disease in diabetic end-stage renal disease. Diabetologia 40:1307-1312, 1997 https://doi.org/10.1007/s001250050825
  2. Bosman DR, Winkler AS, Marsden JT, Macdougall IC, Watkins PJ. Anemia with erythropoietin deficiency occurs early in diabetic nephropathy. Diabetes Care 24:495-499, 2001 https://doi.org/10.2337/diacare.24.3.495
  3. Ishimura E, Nishizawa Y, Okuno S, Matsumoto N, Emoto M, Inaba M, Kawagishi T, Kim CW, Morii H. Diabetes mellitus increases the severity of anemia in non-dialyzed patients with renal failure. J Nephrol 11:83-86, 1998
  4. European Best Practice Guidelines for the management of anemia in patients with chronic renal failure. Working Party for European Best Practice Guidelines for the Management of Anaemia in Patients with Chronic Renal Failure. Nephrol Dial Transplant 14(Suppl 5):1-50, 1999 https://doi.org/10.1093/ndt/14.suppl_4.1a
  5. Eschbach JW, Kelly MR, Haley NR, Abels RI, Adamson JW. Treatment of the anemia of progressive renal failure with recombinant human erythropoietin. N Engl J Med 321:158-163, 1989 https://doi.org/10.1056/NEJM198907203210305
  6. Spivak JL. Serum immunoreactive erythropoietin in health and disease. J Perinat Med 23:13-17, 1995 https://doi.org/10.1515/jpme.1995.23.1-2.13
  7. Adamson JW, Eschbach J, Finch CA. The kidney and erythropoiesis. Am J Med 44:725-733, 1968 https://doi.org/10.1016/0002-9343(68)90254-4
  8. Winearls CG. Historical review on the use of recombinant human erythropoietin in chronic renal failure. Nephrol Dial Transplant 10(Suppl 2):3-9, 1995
  9. Eschbach JW, Adamson JW. Recombinant human erythropoietin: implications for nephrology. Am J Kidney Dis 11:203-209, 1988 https://doi.org/10.1016/S0272-6386(88)80150-1
  10. Danielson B. R HuEPO hyporesponsiveness: - who and why? Nephrol Dial Transplant 10(Suppl 2):69-73, 1995
  11. Drueke TB. R HuEPO hyporesponsiveness: - who and why? Nephrol Dial Transplant 10(Suppl 2):62-68, 1995 https://doi.org/10.1093/ndt/10.supp2.62
  12. Chaplin H Jr, Mollison PL. Red cell life span in nephritis and in hepatic cirrhosis. Clin Sci 12:351-360, 1953
  13. Fukushima Y, Nakamoto Y, Miura AB, Miyagata S, Tsuchida S. The inhibitory factors of hematopoiesis in chronic hemodialysis patients treated with recombinant human erythropoietin. Tohoku J Exp Med 161:217-225, 1990 https://doi.org/10.1620/tjem.161.217
  14. Eschbach JW, Egrie JC, Downing MR, Browne JK, Adamson JW. Correction of the anemia of end-stage renal disease with recombinant human erythropoietin: results of a combined phase I and II clinical trial. N Engl J Med 316:73-78, 1987 https://doi.org/10.1056/NEJM198701083160203
  15. Correa PN, Axelrad AA. Production of erythropoietic bursts by progenitor cells from adult human peripheral blood in an improved serum-free medium: role of insulin‐like growth factor 1. Blood 78:2823-2833, 1991
  16. Deicher R, Horl WH. Hormonal adjuvants for the treatment of renal anemia. Eur J Clin Invest 35(Suppl 3):75-84, 2005 https://doi.org/10.1111/j.1365-2362.2005.01533.x
  17. Axelsson J, Qureshi AR, Heimburger O, Lindholm B, Stenvinkel P, Barany P. Body fat mass and serum leptin levels influence epoetin sensitivity in patients with ESRD. Am J Kid Dis 46:628-634, 2005 https://doi.org/10.1053/j.ajkd.2005.06.004
  18. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 130:461-470, 1999 https://doi.org/10.7326/0003-4819-130-6-199903160-00002
  19. White KE, Bilous RW. Type 2 diabetic patients with nephropathy show structural-functional relationships that are similar to type 1 disease. J Am Soc Nephrol 11:1667-1673, 2000
  20. Keane WF, Brenner BM, de Zeeuw D, Grunfeld JP, McGill J, Mitch WE, Ribeiro AB, Shahinfar S, Simpson RL, Snapinn SM, Toto R. The risk of developing end stage renal disease in patients with type 2 diabetes and nephropathy. Kidney Int 63:1499-1507, 2003 https://doi.org/10.1046/j.1523-1755.2003.00885.x
  21. Hoeldtke RD, Streeten DH. Treatment of orthostatic hypotension with erythropoietin. N Engl J Med 329:611-615, 1993 https://doi.org/10.1056/NEJM199308263290904
  22. Ghirlanda G, Cotroneo P, Todaro L, Pitocco D, Manto A, Storti S, Caputo S, Ricerca BM. Erythropoietin depletion and anemia in diabetes mellitus. Diabet Med 17:410, 2000
  23. Ranmani‐Jourdheuil D, Mourayre Y, Vague P, Boyer J, Juhan-Vague I. In vivo insulin effect on ATPase activities in erythrocyte membrane from insulin dependent diabetics. Diabetes 36:991-995, 1987 https://doi.org/10.2337/diabetes.36.9.991
  24. Bryszewska M, Watala C, Torzecka W. Changes in fluidity and composition of erythrocyte membranes and in composition of plasma lipids in type I diabetes. Br J Haematol 62:111-116, 1986 https://doi.org/10.1111/j.1365-2141.1986.tb02906.x
  25. Sonksen PH, Russell-Jones D, Jones RH. Growth hormone and diabetes mellitus: a review of sixty-three years of medical research and a glimpse into the future? Horm Res 40:68-79, 1993 https://doi.org/10.1159/000183770
  26. Thraikill KM. Insulin-like growth factor-1 in diabetes mellitus: its physiology, metabolic effects, and potential clinical utility. Diabetes Technol Ther 2:69-80, 2000 https://doi.org/10.1089/152091599316775
  27. Garay-Sevilla ME, Nava LE, Malacara JM, Wróbel K, Wróbel K, Pėrez U. Advanced glycosylation end products, insulin-like growth factor-1 and IGF-binding protein-3 in patients with type 2 diabetes mellitus. Diabetes Metab Res Rev 16:106-113, 2000 https://doi.org/10.1002/(SICI)1520-7560(200003/04)16:2<106::AID-DMRR88>3.0.CO;2-H
  28. Brox AG, Zhang F, Guyda H, Gagnon RF. Subtherapeutic erythropoietin and insulin-like growth factor-1 correct the anemia of chronic renal failure in the mouse. Kidney Int 50:937-943, 1996 https://doi.org/10.1038/ki.1996.394
  29. Shih LY, Huang JY, Lee CT. Insulin-like growth factor 1 plays a role in regulating erythropoiesis in patients with end-stage renal disease and erythrocytosis. J Am Soc Nephrol 10:315-322, 1999
  30. Onoyama K, Sanoi T, Motomura K, Fujishima M. Worsening of anemia by angiotensin converting inhibitors and its prevention by antiestrogenic steroid in chronic hemodialysis patients. J Cardiovasc Pharmacol 13(Suppl 3):S27-S30, 1989 https://doi.org/10.1097/00005344-198900133-00007
  31. Fyhrquist F, Karppinen K, Honkanen T, Saijonmaa O, Rosenlof K. High serum erythropoietin levels are normalized during treatment of congestive heart failure with enalapril. J Intern Med 226:257-260, 1989 https://doi.org/10.1111/j.1365-2796.1989.tb01390.x
  32. Vlahakos DV, Canzanello VJ, Madaio MP, Madias NE. Enalaprilassociated anemia in renal transplant patients treated for hypertension. Am J Kidney Dis 17:199-205, 1991 https://doi.org/10.1016/S0272-6386(12)81129-2
  33. Morrone LF, Di Paolo S, Logoluso F, Schena A, Stallone G, Giorgino F, Schena FP. Interference of angiotensin-converting inhibitors on erythropoiesis in kidney transplant recipients: role of growth factors and cytokines. Transplantation 64:913-918, 1997 https://doi.org/10.1097/00007890-199709270-00021