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

Abstract EN

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