Vikrant Sanjay
Department of Nephrology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
Saudi J Kidney Dis Transpl. 2019 Jul-Aug;30(4):932-942. doi: 10.4103/1319-2442.265471.
A retrospective study was conducted over seven years and it aimed to find out various causes of anemia among patients with chronic kidney disease (CKD). The study included nondialysis-dependent adult CKD patients who underwent anemia evaluation. A total of 584 patients were studied. Three hundred and twenty-one (55%) patients were male and 263 (45%) were female. The mean age of the patients was 55.5 ± 14 years. One hundred and seventy-eight (30.5%) had a diabetic CKD and 406 (69.5%) had a nondiabetic CKD. Seventy-two (12.3%) patients were in CKD Stage 3, 193 (33%) patients in CKD Stage 4, and 319 (54.6%) patients in CKD Stage 5. The mean hemoglobin was 9.2 ± 2.2 g/dL. There was a progressive fall in hemoglobin with increasing severity of CKD and in CKD Stage 3, 4, and 5 the mean hemoglobin was 10 ± 2.2, 9.4 ± 2.1, and 8.4 ± 1.9 g/dL, respectively (P = 0.001). Most (47.4%) patients had moderate anemia followed by anemia of mild (31.4%) and severe (21.4%) degrees. Three hundred and seven (52.6%) patients had percent transferrin saturation (TSAT) <20% (functional iron deficiency). One hundred and sixty-two (27.7%) patients had serum ferritin <100 ng/mL (absolute iron deficiency); 334 (57.2%) patients had serum ferritin 100-500 ng/mL, but in 175 (52.4%) of them, TSAT was <20%; 88 (15.1%) patients had serum ferritin >500 ng/mL (58 (65.6%) were C-reactive protein (CRP) + and 55 (62.5%) had TSAT <20%). Overall, 392 (67.1%) patients had functional or absolute iron deficiency. One-third of the patients had elevated CRP levels. The anemia was macrocytic in 20.4% suggesting deficiency of folic acid and/or Vitamin B. A high proportion (74.6%) of patients with normocytic anemia had iron deficiency. In the majority of nondialysis-dependent CKD patients, the etiology of anemia may be multifactorial; therefore, the treatment should be determined by documented causes of anemia.
一项回顾性研究开展了七年，旨在找出慢性肾脏病（CKD）患者贫血的各种原因。该研究纳入了接受贫血评估的非透析依赖成年CKD患者。共研究了584例患者。其中321例（55%）为男性，263例（45%）为女性。患者的平均年龄为55.5±14岁。178例（30.5%）患有糖尿病性CKD，406例（69.5%）患有非糖尿病性CKD。72例（12.3%）患者处于CKD 3期，193例（33%）患者处于CKD 4期，319例（54.6%）患者处于CKD 5期。平均血红蛋白水平为9.2±2.2 g/dL。随着CKD严重程度增加，血红蛋白呈逐渐下降趋势，在CKD 3期、4期和5期，平均血红蛋白分别为10±2.2、9.4±2.1和8.4±1.9 g/dL（P = 0.001）。大多数（47.4%）患者患有中度贫血，其次是轻度（31.4%）和重度（21.4%）贫血。307例（52.6%）患者的转铁蛋白饱和度（TSAT）百分比<20%（功能性缺铁）。162例（27.7%）患者的血清铁蛋白<100 ng/mL（绝对缺铁）；334例（57.2%）患者的血清铁蛋白为100 - 500 ng/mL，但其中175例（52.4%）的TSAT<20%；88例（15.1%）患者的血清铁蛋白>500 ng/mL（58例（65.6%）C反应蛋白（CRP）呈阳性，55例（62.5%）的TSAT<20%）。总体而言，392例（67.1%）患者存在功能性或绝对缺铁。三分之一的患者CRP水平升高。20.4%的患者贫血为大细胞性，提示叶酸和/或维生素B缺乏。正常细胞性贫血患者中很大一部分（74.6%）存在缺铁。在大多数非透析依赖的CKD患者中，贫血的病因可能是多因素的；因此，治疗应根据记录在案的贫血原因来确定。
