{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:26:37Z","timestamp":1789730797391,"version":"4.0.1"},"reference-count":29,"publisher":"American Diabetes Association","issue":"3","content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2001,3,1]]},"abstract":"<jats:p>OBJECTIVE\u2014The normochromic normocytic anemia of erythropoietin (EPO) deficiency is recognized in advanced renal failure but not in early renal disease. The aim of this study was to determine whether anemia with EPO deficiency is found in type 1 diabetic patients with diabetic nephropathy in the absence of advanced renal failure and to compare them with patients with nondiabetic renal disease of similar severity.<\/jats:p>\n                  <jats:p>RESEARCH DESIGN AND METHODS\u2014A total of 27 type 1 diabetic patients with diabetic nephropathy (DN), defined as having persistent proteinuria (mean 1,086 mg\/day [CI 120\u20135,190]), a serum creatinine \u2264180 \u03bcmol\/l, and retinopathy, were compared with 26 nondiabetic patients with glomerulonephritis (GN) and persistent proteinuria (1,874 mg\/day [349\u20135,005]). The Hb concentration, red cell indexes, and serum EPO levels were measured, and other causes for the anemia were excluded. The EPO values were compared with a normal reference range obtained from nondiabetic patients with a microcytic anemia. The DN patients were tested for signs of diabetic peripheral and autonomic neuropathy.<\/jats:p>\n                  <jats:p>RESULTS\u2014We found that 13 of the 27 DN patients were anemic (Hb 10.6 \u00b1 0.9 g\/dl) in marked contrast to none of the GN patients (Hb 13.7 \u00b1 1.4 g\/dl, P &amp;lt; 0.005). In the DN group, serum EPO concentrations failed to increase in response to anemia compared with the response seen in patients with microcytic anemia. Thus, the anemia of the DN group was associated with EPO deficiency. The anemic DN patients showed evidence of more severe proteinuria and diabetic neuropathy than the nonanemic DN patients.<\/jats:p>\n                  <jats:p>CONCLUSIONS\u2014Anemia associated with EPO deficiency can occur early in DN before the onset of advanced renal failure, but does not normally occur in nondiabetic renal disease of similar severity. The pathogenesis requires elucidation. \u2009<\/jats:p>","DOI":"10.2337\/diacare.24.3.495","type":"journal-article","created":{"date-parts":[[2007,3,5]],"date-time":"2007-03-05T17:51:27Z","timestamp":1173117087000},"page":"495-499","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":231,"title":["Anemia With Erythropoietin Deficiency Occurs Early in Diabetic Nephropathy"],"prefix":"10.2337","volume":"24","author":[{"given":"Deborah R.","family":"Bosman","sequence":"first","affiliation":[{"name":"King\u2019s Diabetes Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea S.","family":"Winkler","sequence":"additional","affiliation":[{"name":"King\u2019s Diabetes Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne T.","family":"Marsden","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, and the"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iain C.","family":"Macdougall","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, King\u2019s College Hospital, London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Watkins","sequence":"additional","affiliation":[{"name":"King\u2019s Diabetes Centre"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","reference":[{"key":"2022031215200689700_R1","doi-asserted-by":"crossref","unstructured":"Schuster SJ, Koury ST, Bohrer M, Salceda S, Caro J: Cellular sites of extrarenal and renal erythropoietin production in anemic rats. 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