Predictors of anemia in a multi-ethnic chronic kidney disease population: a case–control study

Abstract

Anemia is a common complication of chronic kidney disease (CKD). However, risk factors of anemia in CKD patients in Singapore are not well established. Hence, a retrospective, case–control study involving non-dialysis CKD patients was conducted to determine possible predictors of anemia in the local CKD population.Non-dialysis adult CKD patients, not receiving renal replacement therapy or erythropoiesis-stimulating-agents were included. Parameters collected included demographics e.g. age, sex and race; clinical data e.g. CKD stage and medical/medication histories; and laboratory data e.g. serum electrolytes, urinary and hematologic parameters. Patients were classified as anemic or non-anemic using a threshold hemoglobin level of 10 g/dL. The parameters were evaluated for their predictive value for anemia development using multivariate logistical regression and calculation of odds ratios. Statistical analyses were performed using STATA.A total of 457 patients (162 anemic and 295 non-anemic) were analysed. Multivariate analysis showed that probability of developing anemia was greater for patients with stage 5 CKD (OR 16.76, p < 0.001), with hematological disorders (OR 18.61, p < 0.001) and with respiratory disorders (OR 4.54, p = 0.004). The probability of developing anemia was lower for patients with higher previous hemoglobin concentration (OR 0.32, p < 0.001) and in those receiving iron supplements (OR 0.44, p = 0.031). Gender and race were not found to be significant predictors of anemia.Risk of anemia is increased in patients with advanced CKD, haematological disorders, respiratory disorders, and those not taking iron supplements. This study has increased our understanding of the patient subgroups at risk for anemia.

Prevalence and Risk Factors Associated With Chronic Kidney Disease Among Patients Presenting at a Haemodialysis Unit in Dodoma, Tanzania

“…Similar findings have been reported from other studies conducted in low-and middle-income countries, whereby hypertension has been reported to be the leading cause of CKD. 2,9,10,13,14 However, these findings are contrary to a community-based study conducted in Northern Tanzania that showed that nearly half (49.2%) of the cases of CKD were not associated with any of the measured risk factors of hypertension, diabetes, or HIV. 16 This discrepancy calls for more research into other causes of CKD, including the use of local herbs and medicines, which is very rampant in this area where this study was conducted.…”

“…In a hospital study conducted in Singapore, researchers found that 87.7% of patients had moderate to severe CKD 13 ; while in another hospital study conducted in Nigeria, found the overall prevalence to be 18.8%. 14 CKD was at least 3 to 4 times more frequent in Africa than in developed countries.…”

“…12 In a study conducted in a hospital in Singapore, researchers found that 87.7% of the patients had moderate to severe CKD (stage 3 and above); the majority of the patients had dyslipidemia (92.8%), hypertension (89.3%) and diabetes mellitus (64.6%). 13 In a study conducted in South Africa's black population, researchers found that primary hypertension occurred in 25.0% of the study population and was considered the cause of stage 5 CKD in 40.0% to 60.0% of these patients. 2 In another study conducted in South Africa, the authors also reported hypertension as the leading cause in the adult population and the cause of chronic kidney failure in 21.0% of patients on renal replacement therapy registry.…”

Anemia increases the mortality risk in patients with stroke: A meta-analysis of cohort studies

“…In addition to other medical complications, anemia dominates for the accumulation damage course of cerebral autoregulation. With the progress of the disease, patients with anemia will suffer from many complications, such as heart failure 31 , chronic kidney disease 32 and vascular endothelial cells 33 34 , which play a more important role than anemia in the development of stroke. This effect may partly explain why Sico and colleagues found a positive relationship in patients with less severe stroke but not in severe stroke 17 .…”

Association of Vitamin D and secondary hyperparathyroidism with anemia in diabetic kidney disease

“…Patients in Stage 5 compared to Stage 4 DKD had significant low level of Hb along with significant low level of Vitamin D and high level of iPTH which is consistent with other studies. [ 9 10 ] However, with significantly high TSAT (Stage 5 vs. Stage 4), Hb was low which may be due to impaired iron release from body stores that is unable to meet the demand for erythropoiesis (also called reticuloendothelial cell iron blockade).…”