Snap shot view on anaemia in chronic kidney disease of uncertain aetiology

Abstract

Aim Anaemia is a well‐known complication of chronic kidney disease but there are no published studies on the pattern of anaemia in chronic kidney disease of uncertain aetiology (CKDu). This study aims to find out the prevalence, causes and associations of anaemia in CKDu to identify any unique features which are different from already described anaemia in chronic kidney disease. Method All (119) biopsy‐confirmed CKDu patients in two endemic clinics (Girandurukotte and Wilgamuwa) were selected as cases. Blood samples (10 mL) were collected from the peripheral veins into Potassium‐Ethylenediaminetetraacetic acid (K‐EDTA) tubes, plain tubes and Na‐citrated tubes. Serum was separated immediately by centrifugation at 3000 rpm for 10 min. Spot urine samples were collected into empty, sterile, polypropylene urine containers. All analyses were performed in IBM spss statistics version 23 (IBM Corp, Armonk, New York). Results The overall prevalence of anaemia in 119 non‐dialysis CKDu patients was 72.3% with the highest prevalence seen in females compared to males (P < 0.001). The prevalence of anaemia in CKDu patients with progression to renal failure was 66.7% – stage 1, 60% – stage 2, 50% – stage 3a, 95% – stage 3b, 79.2% – stage 4 and 100% – stage 5 (P = 0.005). Of CKDu patients, 44.3% had anaemia of chronic disease with iron deficiency. CKDu patients with anaemia had a high inflammatory score were seen in both early and late stages of CKDu. There were a similar proportion of patients with both early and late CKDu having unexplained anaemia. Conclusion The current study showed a significant association of anaemia with disease severity among CKDu patients. Iron deficiency is a crucial aetiology factor of anaemia in CKDu and inflammation likely to effects adversely on anaemia of CKDu.

Quality of Life and Symptom Burden among Chronic Kidney Disease of Uncertain Etiology (CKDu) Patients in Girandurukotte, Sri Lanka

“…A recent study revealed that severity of CKDu is inversely associated with BMI and suggested that low BMI might increase susceptibility to the disease [59]. In the present study, we observed a higher prevalence of anemia among CKDu patients (70.8%), similar to previous findings (72.3%) [60].…”

A Systematic Review of Renal Pathology in Chronic Kidney Disease of Uncertain Etiology

“… 8 Reliance on this histopathological label has led numerous researchers to describe their study subjects as including “biopsy-proven” CKDu patients. 40 , 41 , 42 , 43 , 44 This is potentially misleading. From a pathological point of view, the term tubulointerstitial nephritis (TIN), also referred to as interstitial nephritis, does not represent any specific disease entity and merely represents inflammation within the tubulointerstitium rather than in the glomerular and vascular compartments.…”

Multi-pronged research on endemic chronic kidney disease of unknown etiology in Sri Lanka: a systematic review

“…Fluoride (F - ) exposure via drinking water and its gradual accumulation in the body is nephrotoxic ( Fernando et al 2019a , 2019b , 2019c ; Nanayakkara et al 2020a , 2020b ; Perera et al 2020 ; Thammitiyagodage et al 2017 ). The synergistic influence of F - and water hardness can enhance CKDu (Balasooriya et al 2019 ; Wickramarathna et al 2017 ), particularly when high elevated levels of Mg 2+ contribute to water hardness (Dharmawardana 2017 ; Wickramarathna et al 2017 ).…”

“…Urine is considered an excellent source for biomarkers since markers resulting from the pathophysiological processes in the kidney are released into urine (Fernando et al 2019a , 2019b , 2019c ). Urinary KIM-1 (kidney injury molecule) is a good predictor for renal injury prior to detectable eGFR changes (Ichimura et al 1998 ).…”

“…This can be used as a biomarker for early CKDu detection ( De Silva et al 2016a , 2016b ). While the marker combination of A1M (alpha 1 microglobulin), KIM1, and RBP4 (retinol binding protein 4) can differentiate all CKD categories (CKD + CKDu) from healthy controls, the marker combination OPN (osteopontin), KIM1, and RBP4 can distinguish CKDu patients from CKD (Fernando et al 2019a , 2019b , 2019c ). Fibrinogen and β-2 microglobulin are also suggested as potential tools for CKDu screening but need further validation (Wanigasuriya et al 2017 ) .…”