Renal anemia and hydration status in non-dialysis chronic kidney disease: Is there a link?
J Med Life
; 11(4): 293-298, 2018.
Article
in En
| MEDLINE
| ID: mdl-30894885
ABSTRACT
Rationale Anemia, a common feature in chronic kidney disease (CKD), has multiple contributors to its pathogenesis. Besides the well recognized erythropoietin and iron deficiencies, hydration status might be involved. Objective:
To assess the prevalence and correlations of anemia, iron deficiency and overhydration in patients with stage 2 to 5 CKD. Methods andResults:
This cross-sectional study enrolled 125 erythropoietin and iron therapy naïve non-dialysis CKD patients, without a identifiable cause of anemia. Parameters of hematological, iron, inflammatory and nutritional status were measured. The overhydration parameter (OH) assessed by bioimpedance spectroscopy was used to characterize hydration status. The prevalence of decreased hemoglobin (Hb) <110g/L increased along CKD stages from 0% to 40% (p=0.008). Fluid overload (OH >1L) and lower serum albumin (<40g/L) were more common in stage 5 versus stage 3 CKD (53% vs. 10%, p<0.001, and 27% vs. 3%, p=0.02, respectively), suggesting a potential dilutional reduction in serum proteins. Conversely, decreased iron stores (ferritin <100mcg/L) and iron availability (transferrin saturation, TSAT<0.20) were similarly prevalent irrespective of kidney function decline. Hemoglobin was positively correlated with estimated glomerular filtration rate (eGFR), serum albumin, and transferrin saturation, but inversely with OH. However, in a model of multiple linear regression which explained 32% of hemoglobin variation, only eGFR and overhydration remained the independent predictors of anemia.Discussion:
As fluid overload is a common denominator for hemoglobin and TSAT levels, and is closely related to the declining kidney function, it should be considered in the management of renal anemia, at least in advanced CKD.Key words
(e)GFR: (Estimated) Glomerular filtration rate; BCM: Body composition monitor; CKD: Chronic kidney disease; CRP: C-reactive protein; CVD: Cardiovascular diseases; Chronic Kidney Disease; ESA: Erythropoiesis stimulating agents; ESKD: End-stage kidney disease; Epo: Erythropoietin(s); Fluid overload, Hemoglobin; Hemoglobin: Hb; Iron deficiency, Renal anemia; OH: Overhydration; TSAT: Transferrin saturation
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Renal Dialysis
/
Renal Insufficiency, Chronic
/
Organism Hydration Status
/
Anemia
Type of study:
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
J Med Life
Journal subject:
MEDICINA
Year:
2018
Document type:
Article
Affiliation country:
Romania