Anaemia characteristic in end stage renal disease patients receiving haemodialysis at King Salman armed forced hospital in Tabuk, Saudi Arabia

Abstract

Background Chronic kidney disease (CKD) is a disease associated with high rate of morbidity and mortality primarily due to cardiovascular disease in the form of myocardial infarction and stroke.1 The term "end-stage renal disease" (ESRD) generally refers to CKD treated with renal replacement therapy.2,3 ESRD is on the rise worldwide and has become an increasing public health burden.4,5 The prevalence of anaemia in chronic kidney disease (CKD) population is reaching 50 per cent, furthermore the incidence of anaemia is well collated with CKD severity.6 Anaemia of CKD is usually normocytic normochromic and erythropoietin deficiency is to blame, However, uremicinduced inhibitors of erythropoiesis, shortened red blood cell (RBCs) lifespan and nutritional deficiencies, such as iron, folate and vitamin B12 may be contributors.7-10 Anaemia could lead to deterioration in cardiac function increasing cardiovascular mortality and decreased cognition and mental acuity. For the purpose of the current study, the following definitions were applied: * Chronic kidney disease defined as the functional abnormality of the kidney manifested by elevated serum creatinine of >1.5mg/dl for more than 3 months. * End-stage renal disease (ESRD) is defined as irreversible decline in a person's own kidney function (GFR<15mL/min/1.73m2 or dialysis). * Adequate iron status defined is as a serum ferritin concentration of more than 200ng/mL plus a TSAT value of equal or more than 20 per cent according to KDOQI guidelines. * The target haemoglobin range is haemoglobin values between 11.0 and 12.0g/dL following the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines. In the current study diabetic nephropathy was the most common primary cause of end stage renal disease and hypertension was the commonest co-morbidity, this finding in agreement with GSAM study.16 Targeting haemoglobin concentration more than 12g/dL is not recommended in renal patient, a meta-analysis of nine randomized controlled trials (RCT) that enrolled 5,143 chronic kidney disease patients found a significantly higher risk of all-cause mortality (risk ratio 1.17, 95 per cent CI 1.01-1.35; p=0.031) arteriovenous access thrombosis (risk ratio 1.34, 95 per cent CI 1.16-1.54; p=0.0001), and poorly controlled blood pressure (risk ratio 1.27, 95 per cent CI 1.08-1.50; p=0.004) in the higher haemoglobin target group (12-16g/dL) than in the lower haemoglobin target group (912g/d L).17 Both ferritin and TSAT levels used to assess iron status. [...]both tests may be altered by several factors for example chronic inflammatory state may increase serum ferritin levels that falsely suggest an adequate iron repletion or iron overload and place the patient at risk of iron deficiency if iron therapy inappropriate withdrawal.18 KDOQI guideline defined adequate iron status as a serum ferritin concentration of more than 200ng/mL plus a TSAT value of equal or more than 20 per cent.