Patients with diabetes and kidney disease should prevent anemia

  So, why are diabetic nephropathy patients prone to anemia? Clinical observations have found that the pathogenesis of DKD is not single, and its main factors are: (1) Glucose toxicity. Serum ferritin (SF) is not only an indicator of iron storage in the human body, but also an inflammatory factor. Glucose toxicity is common in DKD patients, which will lead to a decrease in the release of serum iron, which in turn will increase SF and lead to increased oxidative stress in the body. And produce a large number of free radicals and oxidized lipids, leading to and aggravating anemia; (2) deterioration of renal function. In the process of renal function decline, the iron metabolism in the patient’s body is gradually disordered, and the erythropoietin deficiency will increase the incidence of anemia, which is more harmful to the patient and the prognosis is not ideal; (3) Lipid disorder. DKD patients are prone to hypoproteinemia, increased blood viscosity, and vascular circulation disorders, leading to a series of stress reactions in the body, aggravating renal function decline and deterioration; and those with low lipids are prone to malnutrition, while anemia and The nutritional status of the patient is closely related; (4) The blood calcium level is reduced. After the blood calcium drops, the patient’s parathyroid glands will be stimulated, leading to hyperthyroidism, which will increase the thyroid hormone and make the anemia more serious.
  The study also found that male DKD patients with low body mass index (BMI), albumin (Alb), and epidermal growth factor receptor (eGFR) were more prone to anemia; while female DKD patients had low eGFR and low BMI, Decreased blood calcium content is also one of the risk factors for anemia.
  Anemia can affect the cognitive function of DKD patients, induce cardiovascular disease, sharply deteriorate kidney function, and even lead to death. Therefore, DKD patients should strengthen the prevention and treatment of anemia. Regular detection of hemoglobin can be used to detect anemia early, and at the same time evaluate the nutritional status of iron, folic acid, vitamin B12 and other indicators of iron metabolism such as serum ferritin and transferrin.
  If anemia is found, hypocalcemia, malnutrition, iron deficiency, etc. can be corrected through scientific diet. Specifically, the following principles should be followed: (1) DKD patients need to control the hemoglobin level at 100-130g/L, those with the hemoglobin level at 100-110g/L can eat iron-rich food twice a week, and those with the hemoglobin level less than 100g/L can Consume iron-rich foods 3 times a week. (2) Iron is an important raw material for red blood cells to synthesize hemoglobin, so increasing dietary iron intake, especially heme iron, plays a key role in anemia patients. Iron-rich foods are the first to promote animal foods, such as red meat, animal blood, etc., which are rich in heme iron, which can be efficiently transformed and absorbed by the body. (3) Eat more foods with high calcium content, such as milk, soy products, black fungus, river shrimp, seaweed, etc.; patients can insist on eating 300g of milk and dairy products per day under the condition of good water and blood phosphorus control; When the blood potassium concentration is well controlled, eat at least 300-500g of vegetables every day, and half of them must be dark vegetables. (4) A low-potassium, low-phosphorus, low-fat, and low-purine diet should be taken into account while supplementing iron. For some patients with hyperphosphatemia, when choosing iron-rich foods, the food can be boiled in water for a few minutes before continuing to cook , to effectively remove part of the phosphorus, and does not affect the iron supplementation effect of food.
  If the anemia is severe, erythropoiesis-stimulating agents and oral iron (such as ferrous succinate tablets, compound ferrous sulfate folic acid tablets, etc.) or intravenous iron can be used under the guidance of a doctor. If the anemia is particularly severe, blood transfusions may be needed to improve it.

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