Abstract

Anaemia and oxidative stress are frequently comorbid in metabolic disorders such as type 2 diabetes mellitus, 
obesity, metabolic syndrome, and chronic kidney disease. The two processes are bi-directionally linked: oxidative 
stress perturbs iron handling, erythropoiesis, and red blood cell (RBC) lifespan, while anaemia exacerbates tissue 
hypoxia and generates further reactive oxygen and nitrogen species (ROS/RNS). This interplay contributes to 
inflammation, organ dysfunction, reduced exercise capacity, and worsened clinical outcomes. Antioxidant 
therapeutics-ranging from endogenous pathway activators and mitochondria-targeted compounds to nutraceuticals 
and adjunctive agents used with iron or erythropoiesis-stimulating therapies-offer a promising dual strategy to 
simultaneously mitigate oxidative damage and improve hematologic status. This review synthesizes current 
mechanistic understanding of the anaemia-oxidative stress axis in metabolic disease, evaluates classes of antioxidant 
interventions with preclinical and clinical evidence, discusses biomarker-guided use and safety considerations, and 
outlines research priorities to translate antioxidant strategies into improved patient outcomes.