Bone Marrow Hypocellularity in Patients with End-Stage Kidney Disease

Abstract

Background. Anemia and pancytopenia are not uncommon in patients with chronic kidney disease (CKD). Nevertheless, there is insufficient literature analyzing bone marrow pathology in patients with CKD or end-stage kidney disease (ESKD) receiving dialysis. Methods. This observational cohort study included 22 patients with ESKD and 23 patients with CKD that received bone marrow biopsy and aspiration at Chang Gung Memorial Hospital. Demographic, hematological, and biochemical data were collected at the time of bone marrow study for analysis. Results. Bone marrow aspiration demonstrated that patients with ESKD had a lower percentage of blasts than patients with CKD (0.52 ± 0.84 versus 1.06 ± 0.78 %, p = 0.033). Bone marrow biopsy revealed that the overall incidence of hypocellular bone marrow was 55.6%. Furthermore, patients with ESKD had higher proportion of hypocellular bone marrow than patients with CKD (72.7% versus 39.1%, p = 0.023). In a multivariate logistic regression model, it was revealed that ESKD status (odds ratio 9.43, 95% confidence interval 1.66–53.63, p = 0.011) and megakaryocyte count within bone marrow (odds ratio 0.48, 95% confidence interval 0.29–0.79, p = 0.004) were significant predictors for bone marrow hypocellularity. Conclusion. Bone marrow hypocellularity is common in patients with kidney dysfunction. Hypocellular marrow occurs more frequently in patients with ESKD than patients with CKD.

177Lu-DOTATATE Theranostics

“…We included alkaline phosphatase, a reported prognostic marker of progression-free survival in patients with NETs, 20 to explore potential effects of tumor burden. Association of anemia, pancytopenia, bone marrow hypocellularity, and dysfunction of bone marrow–derived stromal cells with chronic kidney disease motivate the remaining factors 21–23 . We chose not to include factors such as age, sex, body size, hypertension, or diabetes as these should be captured by the creatinine level or are included in the eGFR calculation.…”

“…Association of anemia, pancytopenia, bone marrow hypocellularity, and dysfunction of bone marrow-derived stromal cells with chronic kidney disease motivate the remaining factors. [21][22][23] We chose not to include factors such as age, sex, body size, hypertension, or diabetes as these should be captured by the creatinine level or are included in the eGFR calculation. Our relatively small sample size was a consideration for limiting the number of factors from all available.…”

Cardiovascular Consequences of Uremic Metabolites: an Overview of the Involved Signaling Pathways

“…23 The exact cause of bone marrow changes is currently under debate, but the inflammatory status of patients with CKD and EPO deficiency may be 2 of the responsible factors. 23–25…”

“…18,22 Renal anemia is caused by not only precarious erythropoietic capacity and erythrocyte apoptosis but also the incapacity of the bone marrow to sustain the erythropoiesis due to bone marrow hypocellularity, which leads to reduced erythrocyte production. 23 The exact cause of bone marrow changes is currently under debate, but the inflammatory status of patients with CKD and EPO deficiency may be 2 of the responsible factors. [23][24][25] Therefore, renal anemia develops in the context of (1) insufficient EPO production mostly due to kidney fibrosis; (2) shortened red blood cell lifetime and nutritional deficiencies, such as folate, vitamin B12, and iron deficiency 26 ; and (3) bone marrow changes.…”

“…23 The exact cause of bone marrow changes is currently under debate, but the inflammatory status of patients with CKD and EPO deficiency may be 2 of the responsible factors. [23][24][25] Therefore, renal anemia develops in the context of (1) insufficient EPO production mostly due to kidney fibrosis; (2) shortened red blood cell lifetime and nutritional deficiencies, such as folate, vitamin B12, and iron deficiency 26 ; and (3) bone marrow changes. All of these factors acting together have systemic and extra-renal organ-injuring consequences, including the induction of cardiovascular dysfunction.…”