Etiological spectrum of anemia in non-dialysis-dependent chronic kidney disease: A single-center study from India

Saudi J Kidney Dis Transpl. 2019 Jul-Aug;30(4):932-942. doi: 10.4103/1319-2442.265471.

Abstract

A retrospective study was conducted over seven years and it aimed to find out various causes of anemia among patients with chronic kidney disease (CKD). The study included nondialysis-dependent adult CKD patients who underwent anemia evaluation. A total of 584 patients were studied. Three hundred and twenty-one (55%) patients were male and 263 (45%) were female. The mean age of the patients was 55.5 ± 14 years. One hundred and seventy-eight (30.5%) had a diabetic CKD and 406 (69.5%) had a nondiabetic CKD. Seventy-two (12.3%) patients were in CKD Stage 3, 193 (33%) patients in CKD Stage 4, and 319 (54.6%) patients in CKD Stage 5. The mean hemoglobin was 9.2 ± 2.2 g/dL. There was a progressive fall in hemoglobin with increasing severity of CKD and in CKD Stage 3, 4, and 5 the mean hemoglobin was 10 ± 2.2, 9.4 ± 2.1, and 8.4 ± 1.9 g/dL, respectively (P = 0.001). Most (47.4%) patients had moderate anemia followed by anemia of mild (31.4%) and severe (21.4%) degrees. Three hundred and seven (52.6%) patients had percent transferrin saturation (TSAT) <20% (functional iron deficiency). One hundred and sixty-two (27.7%) patients had serum ferritin <100 ng/mL (absolute iron deficiency); 334 (57.2%) patients had serum ferritin 100-500 ng/mL, but in 175 (52.4%) of them, TSAT was <20%; 88 (15.1%) patients had serum ferritin >500 ng/mL (58 (65.6%) were C-reactive protein (CRP) + and 55 (62.5%) had TSAT <20%). Overall, 392 (67.1%) patients had functional or absolute iron deficiency. One-third of the patients had elevated CRP levels. The anemia was macrocytic in 20.4% suggesting deficiency of folic acid and/or Vitamin B12. A high proportion (74.6%) of patients with normocytic anemia had iron deficiency. In the majority of nondialysis-dependent CKD patients, the etiology of anemia may be multifactorial; therefore, the treatment should be determined by documented causes of anemia.

MeSH terms

  • Adult
  • Aged
  • Anemia / blood
  • Anemia / diagnosis
  • Anemia / epidemiology*
  • Anemia, Iron-Deficiency / blood
  • Anemia, Iron-Deficiency / diagnosis
  • Anemia, Iron-Deficiency / epidemiology
  • Anemia, Macrocytic / blood
  • Anemia, Macrocytic / diagnosis
  • Anemia, Macrocytic / epidemiology
  • Biomarkers / blood
  • C-Reactive Protein / analysis
  • Female
  • Ferritins / blood
  • Hemoglobins / metabolism
  • Humans
  • India / epidemiology
  • Male
  • Middle Aged
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / epidemiology*
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Transferrin / analysis

Substances

  • Biomarkers
  • Hemoglobins
  • Transferrin
  • C-Reactive Protein
  • Ferritins