This higher incidence of anemia in CKD patients with DM might be associated with urinary albumin excretion, chronic inflammation, glomerular hyperfiltration, oxidative stress, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, loss of peritubular capillaries, up regulation of the local renin–angiotensin system, effects of autonomic neuropathy, and microvascular damage [12–16]. Here, ACE is linked to autonomic neuropathy.