Anemia in Patients with Chronic Kidney Disease

The purpose of the study was to improve the quality of diagnosis of anemia of renal origin by studying the non-heme iron state in patients with different stages of chronic kidney disease (CKD). Material and methods. The study included 79 patients with CKD (28 – male, 51 – female) aged 33-72. Depending on the presence/absence of anemia patients were divided into two groups. Group I included 24 patients without anemia, group II included 55 patients with anemia. Patients of group II were divided into 3 subgroups depending on the severity of anemia: 31 patients (subgroup 1) – with mild degree of anemia, 18 patients (subgroup 2) – moderate degree, 6 patients (subgroup 3) – severe degree. The control group consisted of 20 healthy people. A complete hematology panel, urine tests, kidney ultrasound, serum urea and creatinine levels, glomerular filtration rate (GFR) by CKD-EPI were performed. The serum iron levels, total and latent serum iron ability by ferritin and transferrin levels were measured. Results and discussion. Among patients with CKD there were 58% of II and III stages, and 42% of CKD of IV-V stages. Anemia of mild degree was revealed in 56% cases; moderate degree of anemia had 33% of patients and 11% had severe degree of anemia. In case of anemia of renal origin serum creatinine and urea levels were increasing, and GFR decreased, serum hemoglobin, hematocrit, iron, transferrin, and ferritin levels also deceased. Intensiveness of this parameters are the most pronounced in patients with severe anemia that was confirmed by exiting positive correlations between hemoglobin and serum iron and transferrin levels. To assess the severity of anemia we studied the correlation relationships between indicators of heme and non-heme iron. Group II patients revealed a direct correlation between the levels of hemoglobin and serum iron (r = 0.4751; p = 0.0008) and between levels of hemoglobin and transferrin (r = 0.1819; p = 0.0005). We found a weak correlation strength (r = 0.1067; p = 0.0008) between levels of hemoglobin and ferritin. The anemia in patients with CKD and increased levels of creatinine, urea and GFR decline, reduced levels of serum iron, transferrin marked downward trend ferritin. These changes depend on the severity of anemia and most pronounced in patients with severe anemia, which found direct correlation confirm the relationship between hemoglobin and serum iron and transferrin in patients with CKD. Conclusions. Iron-deficiency anemia is characteristic for CKD patients. Decreasing serum iron, transferrin and ferritin levels determines severity of anemia degree and CKD current. The lowest non-heme iron levels are typical for patients with CKD of IV-V stages and severe anemia degree.