Anaemia among primary care patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD)

A multicentred cross-sectional study

Iliza Idris, Hizlinda Tohid, Noor Azimah Muhammad, Mohd Radzniwan A. Rashid, Azainorsuzila Mohd Ahad, Norsiah Ali, Naemah Sharifuddin, Junita Harizon Aris

Research output: Contribution to journalArticle

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Abstract

Objectives This study aimed to determine the prevalence of anaemia among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) at primary care settings and its associated factors. Design, setting and participants This cross-sectional study involved 808 adult patients with T2DM and CKD who were recruited via systematic sampling from 20 public primary care clinics in Peninsular Malaysia. Their sociodemographic, clinical and biomedical profiles were collected through interviews, examination of medical records and blood testing. Results The prevalence of anaemia was 31.7% (256/808). The anaemia was mainly mild (61.5%) and normocytic normochromic (58.7%). About 88.7% of the patients with anaemia were not known to have anaemia prior to the study. Among 36 patients with documented history of anaemia, 80.6% were still anaemic, and only a half received iron therapy. Multivariate regression analysis showed that women (adjusted odd ratio (AOR): 1.57, 95% CI: 1.12 to 2.21, p=0.009) and those with older age (AOR: 1.04, 95% CI: 1.01 to 1.06, p<0.001), CKD stage 3a (AOR: 2.47; 95% CI: 1.25 to 4.87, p=0.009), CKD stage 3b (AOR: 4.36; 95% CI: 2.14 to 8.85, p<0.001), CKD stage 4 (AOR: 10.12; 95% CI: 4.36 to 23.47, p<0.001), CKD stage 5 (AOR: 10.80; 95% CI: 3.32 to 35.11, p<0.001) and foot complication (AOR 3.12, 95% CI: 1.51 to 6.46, p=0.002) were more likely to have anaemia. Having higher body mass index (AOR 0.95, 95% CI: 0.92 to 0.99, p=0.012) and higher diastolic blood pressure (AOR 0.97, 95% CI: 0.95 to 0.99, p<0.001) were associated with lower odds to have anaemia. Conclusion Anaemia among patients with T2DM and CKD in primary care was common, and the majority was unrecognised. Inadequate treatment of anaemia was also prevalent. Therefore, screening of anaemia should be incorporated into the routine assessment of diabetic complications particularly for those with significant associated factors. It is hoped that such strategy could lead to early treatment and hence improve their overall care.

Original languageEnglish
Article numbere025125
JournalBMJ Open
Volume8
Issue number12
DOIs
Publication statusPublished - 1 Dec 2018

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Chronic Renal Insufficiency
Type 2 Diabetes Mellitus
Anemia
Primary Health Care
Cross-Sectional Studies
Odds Ratio
Malaysia
Diabetes Complications
Medical Records
Foot
Body Mass Index
Therapeutics
Multivariate Analysis
Iron
Regression Analysis
Interviews
Blood Pressure
Hypertension

Keywords

  • anaemia
  • chronic kidney disease
  • diabetes mellitus
  • primary care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Anaemia among primary care patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) : A multicentred cross-sectional study. / Idris, Iliza; Tohid, Hizlinda; Muhammad, Noor Azimah; Rashid, Mohd Radzniwan A.; Ahad, Azainorsuzila Mohd; Ali, Norsiah; Sharifuddin, Naemah; Aris, Junita Harizon.

In: BMJ Open, Vol. 8, No. 12, e025125, 01.12.2018.

Research output: Contribution to journalArticle

Idris, Iliza ; Tohid, Hizlinda ; Muhammad, Noor Azimah ; Rashid, Mohd Radzniwan A. ; Ahad, Azainorsuzila Mohd ; Ali, Norsiah ; Sharifuddin, Naemah ; Aris, Junita Harizon. / Anaemia among primary care patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) : A multicentred cross-sectional study. In: BMJ Open. 2018 ; Vol. 8, No. 12.
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title = "Anaemia among primary care patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD): A multicentred cross-sectional study",
abstract = "Objectives This study aimed to determine the prevalence of anaemia among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) at primary care settings and its associated factors. Design, setting and participants This cross-sectional study involved 808 adult patients with T2DM and CKD who were recruited via systematic sampling from 20 public primary care clinics in Peninsular Malaysia. Their sociodemographic, clinical and biomedical profiles were collected through interviews, examination of medical records and blood testing. Results The prevalence of anaemia was 31.7{\%} (256/808). The anaemia was mainly mild (61.5{\%}) and normocytic normochromic (58.7{\%}). About 88.7{\%} of the patients with anaemia were not known to have anaemia prior to the study. Among 36 patients with documented history of anaemia, 80.6{\%} were still anaemic, and only a half received iron therapy. Multivariate regression analysis showed that women (adjusted odd ratio (AOR): 1.57, 95{\%} CI: 1.12 to 2.21, p=0.009) and those with older age (AOR: 1.04, 95{\%} CI: 1.01 to 1.06, p<0.001), CKD stage 3a (AOR: 2.47; 95{\%} CI: 1.25 to 4.87, p=0.009), CKD stage 3b (AOR: 4.36; 95{\%} CI: 2.14 to 8.85, p<0.001), CKD stage 4 (AOR: 10.12; 95{\%} CI: 4.36 to 23.47, p<0.001), CKD stage 5 (AOR: 10.80; 95{\%} CI: 3.32 to 35.11, p<0.001) and foot complication (AOR 3.12, 95{\%} CI: 1.51 to 6.46, p=0.002) were more likely to have anaemia. Having higher body mass index (AOR 0.95, 95{\%} CI: 0.92 to 0.99, p=0.012) and higher diastolic blood pressure (AOR 0.97, 95{\%} CI: 0.95 to 0.99, p<0.001) were associated with lower odds to have anaemia. Conclusion Anaemia among patients with T2DM and CKD in primary care was common, and the majority was unrecognised. Inadequate treatment of anaemia was also prevalent. Therefore, screening of anaemia should be incorporated into the routine assessment of diabetic complications particularly for those with significant associated factors. It is hoped that such strategy could lead to early treatment and hence improve their overall care.",
keywords = "anaemia, chronic kidney disease, diabetes mellitus, primary care",
author = "Iliza Idris and Hizlinda Tohid and Muhammad, {Noor Azimah} and Rashid, {Mohd Radzniwan A.} and Ahad, {Azainorsuzila Mohd} and Norsiah Ali and Naemah Sharifuddin and Aris, {Junita Harizon}",
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TY - JOUR

T1 - Anaemia among primary care patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD)

T2 - A multicentred cross-sectional study

AU - Idris, Iliza

AU - Tohid, Hizlinda

AU - Muhammad, Noor Azimah

AU - Rashid, Mohd Radzniwan A.

AU - Ahad, Azainorsuzila Mohd

AU - Ali, Norsiah

AU - Sharifuddin, Naemah

AU - Aris, Junita Harizon

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Objectives This study aimed to determine the prevalence of anaemia among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) at primary care settings and its associated factors. Design, setting and participants This cross-sectional study involved 808 adult patients with T2DM and CKD who were recruited via systematic sampling from 20 public primary care clinics in Peninsular Malaysia. Their sociodemographic, clinical and biomedical profiles were collected through interviews, examination of medical records and blood testing. Results The prevalence of anaemia was 31.7% (256/808). The anaemia was mainly mild (61.5%) and normocytic normochromic (58.7%). About 88.7% of the patients with anaemia were not known to have anaemia prior to the study. Among 36 patients with documented history of anaemia, 80.6% were still anaemic, and only a half received iron therapy. Multivariate regression analysis showed that women (adjusted odd ratio (AOR): 1.57, 95% CI: 1.12 to 2.21, p=0.009) and those with older age (AOR: 1.04, 95% CI: 1.01 to 1.06, p<0.001), CKD stage 3a (AOR: 2.47; 95% CI: 1.25 to 4.87, p=0.009), CKD stage 3b (AOR: 4.36; 95% CI: 2.14 to 8.85, p<0.001), CKD stage 4 (AOR: 10.12; 95% CI: 4.36 to 23.47, p<0.001), CKD stage 5 (AOR: 10.80; 95% CI: 3.32 to 35.11, p<0.001) and foot complication (AOR 3.12, 95% CI: 1.51 to 6.46, p=0.002) were more likely to have anaemia. Having higher body mass index (AOR 0.95, 95% CI: 0.92 to 0.99, p=0.012) and higher diastolic blood pressure (AOR 0.97, 95% CI: 0.95 to 0.99, p<0.001) were associated with lower odds to have anaemia. Conclusion Anaemia among patients with T2DM and CKD in primary care was common, and the majority was unrecognised. Inadequate treatment of anaemia was also prevalent. Therefore, screening of anaemia should be incorporated into the routine assessment of diabetic complications particularly for those with significant associated factors. It is hoped that such strategy could lead to early treatment and hence improve their overall care.

AB - Objectives This study aimed to determine the prevalence of anaemia among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) at primary care settings and its associated factors. Design, setting and participants This cross-sectional study involved 808 adult patients with T2DM and CKD who were recruited via systematic sampling from 20 public primary care clinics in Peninsular Malaysia. Their sociodemographic, clinical and biomedical profiles were collected through interviews, examination of medical records and blood testing. Results The prevalence of anaemia was 31.7% (256/808). The anaemia was mainly mild (61.5%) and normocytic normochromic (58.7%). About 88.7% of the patients with anaemia were not known to have anaemia prior to the study. Among 36 patients with documented history of anaemia, 80.6% were still anaemic, and only a half received iron therapy. Multivariate regression analysis showed that women (adjusted odd ratio (AOR): 1.57, 95% CI: 1.12 to 2.21, p=0.009) and those with older age (AOR: 1.04, 95% CI: 1.01 to 1.06, p<0.001), CKD stage 3a (AOR: 2.47; 95% CI: 1.25 to 4.87, p=0.009), CKD stage 3b (AOR: 4.36; 95% CI: 2.14 to 8.85, p<0.001), CKD stage 4 (AOR: 10.12; 95% CI: 4.36 to 23.47, p<0.001), CKD stage 5 (AOR: 10.80; 95% CI: 3.32 to 35.11, p<0.001) and foot complication (AOR 3.12, 95% CI: 1.51 to 6.46, p=0.002) were more likely to have anaemia. Having higher body mass index (AOR 0.95, 95% CI: 0.92 to 0.99, p=0.012) and higher diastolic blood pressure (AOR 0.97, 95% CI: 0.95 to 0.99, p<0.001) were associated with lower odds to have anaemia. Conclusion Anaemia among patients with T2DM and CKD in primary care was common, and the majority was unrecognised. Inadequate treatment of anaemia was also prevalent. Therefore, screening of anaemia should be incorporated into the routine assessment of diabetic complications particularly for those with significant associated factors. It is hoped that such strategy could lead to early treatment and hence improve their overall care.

KW - anaemia

KW - chronic kidney disease

KW - diabetes mellitus

KW - primary care

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U2 - 10.1136/bmjopen-2018-025125

DO - 10.1136/bmjopen-2018-025125

M3 - Article

VL - 8

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

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