ABSTRACT

Introduction: Iron deficiency is an important cause of anemia in patients with chronic kidney disease (CKD). Anemia develops early during chronic kidney disease (CKD), affects virtually all individuals with stage 5 CKD (GFR <15 ml/min per 1.73 m2), and is associated with increased cardiovascular morbidity and decreased quality of life. Iron deficiency is a common cause of anemia in CKD; the estimated prevalence ranges from 25 to 70%. The causes include decreased intake or absorption of iron; iron sequestration as a result of inflammation; blood loss; and increased iron use for red blood cell production in response to erythropoiesis stimulating agents (ESA). Inadequate production of erythropoietin by the kidney and/or insufficient response to erythropoietin as a result of inflammation contributes to anemia during later stages of CKD. Appropriate management of anemia in CKD often requires both iron and ESA. Thus, assessing iron status is integral to both iron and anemia management in CKD patients, as iron is essential for Hb formation (as is erythropoietin). Objective: To determine the frequency of iron deficiency anemia in patients with advanced chronic kidney disease presenting to a tertiary care hospital in Karachi. Subjects and Methods: Patients with advance chronic kidney disease attending the nephrology out-patients clinic at Aga Khan University Hospital who fulfilled the inclusion and exclusion criteria were included. Patients were tested for hemoglobin level and transferrin saturation. Those who had both, anemia and iron deficiency were taken as having iron deficiency anemia. Mean and standard deviations was calculated for the quantitative variables and frequencies and percentages was calculated for the qualitative variables Effect modifiers were controlled through stratification of age and gender to see the effect of these on the outcome variable. Post stratification chi square test was applied. P-value of ? 0.05 was taken as significant. Results: A total of 145 diagnosed advance chronic kidney disease patients attending the nephrology out-patients clinic at Nephrology Department, Aga Khan University Hospital, Karachi who met the inclusion and exclusion criteria were included in this study. Mean age in our study was 49.06 years with the standard deviation of ±10.08. Mean hemoglobin and transferrin saturation in our study was 9.53±2.47 g/dl and 13.99±7.87 % respectively.89 (61.4%) were male and 56 (38.6%) were female. Out of 145 patients, 118 (81.4%) had iron deficiency anemia and 27 (18.6%) had no iron deficiency anemia in advance chronic kidney disease patients. Conclusion: Anemia seen in chronic kidney disease (CKD) patients not on dialysis can be attributed significantly to iron deficiency, and that adequate iron replacement can cause a marked improvement in the anemia even without the use of erythropoietin. Replenishing iron stores in anemic patients with chronic kidney disease significantly increases hemoglobin levels and should be considered as an integral part of the therapy for treating anemia in advanced chronic kidney disease patient population. It is important that regular screening of iron deficiency in renal failure patients should be made part of the treatment and management in order to prevent adverse outcomes. Keywords: Chronic advance kidney disease, iron deficiency anemia, hemoglobin and transferrin saturation
Publication date: 01/04/2020

https://ijbpas.com/pdf/2020/April/MS_IJBPAS_2020_5031.pdf

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https://doi.org/10.31032/IJBPAS/2020/9.4.5031