Keywords
How to Cite
Abstract
Introduction: Anemia and iron deficiency are very prevalent conditions in hemodialysis and have been associated with an increase in morbidity and mortality.
Objective: Describe the characteristics of iron deficiency and anemia in patients with end-stage renal disease on hemodialysis, and analyze the parameters of the blood count to predict iron deficiency in them.
Materials and methods: A cross-sectional descriptive study carried out in the hemodialysis unit of the Specialties Hospital of the Armed Forces No. 1 and CLINEF Norte, Quito, Ecuador, during December 2018 and January 2019. The analysis was based on the comparison of two groups, ferropenic and non-ferropenic patients.
Results: We included 268 patients with an average age of 59.16 years; 89 patients (33.21%) were ferropenic. However, they presented normal hematimetric parameters in most of them. We also found that 80.22% of the patients included were anemic, with little frequency of microcytosis and hypochromia. Among them, 33.21% were ferropenic, being hemoglobin a poor marker of iron deficiency. Additionally, to predict ferropenia, and not to have ferritin or transferrin saturation, we find especially useful the mean corpuscular hemoglobin, mean corpuscular volume, erythrocyte distribution width, and Srivastava index, however the predictive value increases when including the syderemia as in our proposed model.
Conclusions: Given the high frequency of anemia without hypochromia or microcytosis in patients with end-stage renal disease on hemodialysis, even in iron deficiency, regular evaluation of ferric metabolism is essential, as well as the analysis of the blood count with a focus on the dialysis patient.
References
Babitt JL, Lin HY. Mechanisms of Anemia in CKD. JASN, 2012:23(10);1631-1634. https://doi.org/10.1681ASN.2011111078
Cappellini MD, Comin-Colet J, de Francisco A, Dignass A, Doehner W, Lam CS, et al. Iron deficiency across chronic inflammatory conditions: International expert opinion on definition, diagnosis, and management. Am J Hematol. 2017;92(10):1068-1078. https://doi.org/10.1002/ajh.24820
Wish JB, Aronoff GR, Bacon BR, Brugnara C, Eckardt KU, Ganz T, et al. Positive Iron Balance in Chronic Kidney Disease: How Much is Too Much and How to Tell? Am J Nephrol. 2018;47:72-83. https://doi.org/10.1159000486968
Fishbane S, Spinowitz B. Update on Anemia in ESRD and Earlier Stages of CKD: Core Curriculum 2018. Am J Kidney Dis 2018. 71(3):423-435. https://doi.org/ 10.1053/j.ajkd.2017.09.026
Organización Mundial de la Salud [Internet]. Ginebra: Concentraciones de hemoglobina para diagnosticar la anemia y evaluar su gravedad; c2019 [updated 2013 Aug 12; cited 2019 Jan 10]. Available from: http://apps.who.int/iris/bitstream/handle/10665/85842/ WHO_NMH_NHD_MNM_11.1_spa.pdf? sequence=7&isAllowed=y
Dignass A, Farrag Ka, Stein J. Limitations of Serum Ferritin in Diagnosing Iron Deficiency in Inflammatory Conditions. International Journal of Chronic Diseases, 2018;2018:1-11. https://doi.org/10.1155/2018/9394060
Nasouti MA, Ahmadi Halili S, Beladi Mousavi Z, Nasouti A, Tamadon MR. Anemia among hemodialysis patients; an updated mini- review. Ann Res Dial. 2017; 2(1):e03
KDOQI National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis. 2006;47(5Suppl 3):S11-145. https://doi.org/10.1053j.ajkd.2006.03.010
Koulouridis I, Alfayez M, Trikalinos TA, Balk EM, Jaber BL. Dose of erythropoiesis-stimulating agents and adverse outcomes in CKD: a metaregression analysis. Am J Kidney Dis. 2013;61(1):44-56. https://doi.org/10.1053j.ajkd.2012.07.014
Szczech LA, Barnhart HX, Inrig JK, Reddan DN, Sapp S, Califf RM, et al. Secondary analysis of the CHOIR trial epoetin-alpha dose and achieved hemoglobin outcomes. Kidney Int. 2008;74(6):791-798. https://doi.org/10.1038/ki.2008.295
Afshar R, Sanavi S, Salimi J, Ahmadzadeh M. Hematological profile of chronic kidney disease (CKD) patients in Iran, in pre-dialysis stages and after initiation of hemodialysis. Saudi J Kidney Dis Transpl. 2010;21(2):368-371.
Valenti L, Messa P, Pelusi S, Campostrini N, Girelli D. Hepcidin levels in chronic hemodialysis patients: a critical evaluation. Clin Chem Lab Med. 2014;52(5):613-9. https://doi.org/10.1515/cclm-2013-0769
Liu Y, Zhang R, Zhu L. Clinical significance of serum hepcidin for the treatment of anemia in maintenance hemodialysis patients. Int J Clin Exp Pathol. 2016;9(6):6549-6553.
Johnson-Wimbley TD, Graham DY. Diagnosis and management of iron deficiency anemia in the 21st century. Therap Adv Gastroenterol. 2011;4(3):177-84. https://doi.org/10.1177/1756283X11398736
Al-Ageel NA, Al-Aqeel SA, Abanmy NO, Alwakeel JS, Sabry A, Alsaran KA. Appropriateness of anemia management in hemodialysis patients. Saudi Pharm J. 2011;20(1):85-91. https://doi.org/10.1016/j.jsps.2011.08.007
Zadrazil J, Horak P. Pathophysiology of anemia in chronic kidney diseases: A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015;159(2):197-202. https://doi.org/10.5507/bp.2013.093
Amini M, Khosravi M, Baradaran HR, Atlasi R. Vitamin B12 supplementation in end stage renal diseases: a systematic review. Med J Islam Repub Iran. 2015;29:167. Published 2015 Jan 27.