Background: Anemia is common and early complication of chronic kidney disease patients one contributing factor is iron deficiency which may be problematic during erythropoietin therapy.The approximate prevalence of CKD is 800 per million population, and the incidence of end stage renal disease (ESRD) is 150- 200 per million population. Anemia of chronic disease is a complex disorder determined by variety of factors. Although the primary defect is decreased erythropoietin production from the kidney, a number of other factors may play contributory roles. For example iron, folate, vitamin B12 deficiency due to nutritional insufficiency or increased blood loss, shortened RBC survival, hyperparathyroidism, mild chronic inflammation and aluminum toxicity. Anemia in CKD worsens comorbidities of diabetes and hypertension, contributing to poor outcome and high mortality. Untreated chronic anemia leads to a number of physiologic disorders including cardiovascular complications and increased mortalityand morbidity. According to GFR and 2006 NKF-K/DOQI guidelines, CKD has been divided into 5 stages 3, 4. Anemia usually appears at GFR below 60ml/min or at stage 3.Renal insufficiency is also associated with bleeding tendency attributed to platelet dysfunction due to abnormal platelet aggregation and adhesiveness, 6. White blood cell count may be decreased in uremic patients and anemia correction is followed by an increase in natural killer cells and improvement in leukocyte phagocytic function. Aim 1. To assess hematological profile and serum iron indices in non dialysis Chronic Kidney Disease patients. 2. To detect the types of anemia in CKD patients. 3. To detect the prevalence of iron deficiency in non dialysis CKD patients according to National Kidney Foundation's Kidney Disease Quality Iniatiative Guidelines (NKFK/DOQI). Materials and Methods: It is a cross-sectional study conducted in the medical wards of Santhiram medical College and General hospital, Nandyal. A total of 54 patients were included in our study who satisfied the diagnostic criteria of CKD and patients underwent clinical and renal parameters, haematological profile and iron status. For comparison of the results with the general population adequate number of controls were taken. Results: Our study results showed low level of Haemoglobin, and packed cell volume with icrease in severity of chronic kidney disease. Bleeding time was increased in 5.6% patients and elevated ESR was present in more than half of patients. Anemia was universal in our population. Normocytic normochromic anemia was found in 70.4% of the patients and microcytic hypochromic anemia in another 20.4%, and 9.2% had both type of peripheral smear picture. Applying the NKF-K/DOQI guidelines for nondialysis chronic kidney disease to our population it was found that nearly 38.9% of the study population did not have target serum ferritin of 100 ng/ml and 44.4% of study population did not have target TSAT of >20%. Conclusion: It's crucial to investigate and manage iron deficiency in patients with chronic kidney disease (CKD) to identify underlying causes and provide targeted treatment. Every effort should be made to determine the cause of anemia in CKD patients and address coexisting iron deficiency anemia. Additionally, monitoring other hematological parameters can help detect any coexisting abnormalities.
Gurugubelli et al. (Sun,) studied this question.