Exploring hematological profiles in chronic kidney disease (CKD): Focus on reticulocyte production index with correlation between grade 4 and grade 5 CKD at a rural tertiary care referral center

Context: Kidney diseases are one of the top three life-threatening diseases in India. Chronic kidney disease (CKD) manifests with chronic anemias due to bone marrow hypoproliferation. Hematological parameters assessment and reticulocyte production index (RPI) help in the management of anemias in G4 and G5 stages of CKD cases. Hence, an attempt was made to study all the hematological parameters in CKD cases. Aims: The objectives were to describe the hematological profile of patients with CKD and also to correlate the hematological parameters with G4 and G5 grades of CKD. Methods and Material: The study population included 120 CKD patients. The patients on hematinics or erythropoietin therapy were excluded. The hematological investigations were performed and then correlated with the grades of CKD. Results: The mean age of the study population was found to be 49.1 ± 14.7 years. The majority were males (74.1%). More than 85% of patients were having grade 5 CKD. The mean hemoglobin and mean red blood cell (RBC) count were 7.8 ± 1.7g/dl and 2.78 ± 0.7/L, respectively. The decrease in hemoglobin and RBC count inversely correlated with CKD grade. The reticulocyte count decreased as the grade progressed. The mean difference of reticulocyte index between G4 and G5 was found to be statistically significant ( P = 0.025). The reticulocyte production index (RPI) was found to be <2 in all the CKD cases included in the study. The mean white blood cell count and mean platelet count were 7.1 × 10 9 /L and 202 × 10 9 /L, respectively. The predominant peripheral smear finding was normocytic normochromic anemia (86.6%). Conclusion: CKD occurred in all age groups with a high incidence among the males. The most common form of anemia was found to be normocytic normochromic anemia, with increasing prevalence as the grade progressed from G4 to G5. The RPI was <2, which indicates marrow proliferation status.