Patterns and Factors Influencing Anaemia in Chronic Renal Failure

INTRODUCTION: Fishberg defined uremia in accord with its etymology and original meaning, as a complex of symptoms resulting from failing renal function caused by retention of constituents of normal urine. It is a generalized symptom complex due to a dynamic imbalance between the organism’s current metabolism and appropriate renal function. Richard Bright first described the association between anaemia and chronic renal failure. A normocytic normochromic anaemia is present in majority of patients with chronic renal disease, usually observed when glomerular filtration rate falls below 30 ml/min. AIMS OF THE STUDY: Much of the morbidity and mortality in renal failure patients can be attributed to secondary consequences of chronic anaemia31. Other factors associated with chronic renal failure may contribute to development of anaemia but erythropoietin deficiency is by far the major factor. Life long replacement therapy with erythropoietin for anaemia correction in chronic renal failure is out of reach for most of our patients who belong to the lower socioeconomic strata. More over many other factors like malnutrition, iron deficiency etc., may be contributing to renal anaemia, correction of which can reduce morbidity due to anaemia considerabley. The purpose of the study is to identify such additional risk factors of anaemia in chronic renal failure. Rationale: By this study, we try to analyze on morphological and distribution patterns of anaemia and its correctable contributing factors if any, so that some benefits can be extended to non affluent renal disease patients also. MATERIALS AND METHODS: Study Design: This will be a cross-sectional study of patients with chronic renal disease and anaemia chosen from Department of Nephrology based on the criteria from January 2008 to August 2008. We propose to study 50 cases of hospital admission for minor ailment (e.g. viral fever) as controls. Selection and Enrolement of Cases: Inclusion Criteria: a. All patients should be diagnosed cases of chronic renal disease with anaemia. b. None of the patients should have received erythropoietin therapy. c. Patients should not be having other significant systemic involvement other than due to uraemia. Exclusion Criteria: Patients having any contraindications as per inclusion criteria shall be excluded from the study. Data Collection: Simple proforma containing details of patients will be filled up. The following biochemical parameters were assessed as follows: Haemoglobin: cyanmeth method, Serum creatinine: alkaline picrate method, Feritin: antiferritin labeled with lodine 125, TIBC: Incubating with serum ferric ammonium citrate, Protein: Biuret method, Albumin: using bromocresol green, Cholesterol: Enzymatic colourimetric test, Alkaline phosphatase: p-nitro phenol phosphate, Cholesterol: Enzymatic colourimetric test, Alkaline phosphatase: p-nitro phenol phosphate, Phosphorous: Molydate u.v. method, Stoll occult blood: Guaic test, Uric acid: Spectrophotometric uricase/peroxidase. CONCLUSIONS: This study indicates that: 1. Severity of anemia correlates well with the degree of renal disease. 2. Normochromic normocytic morphology anemia caused by erythropoietin deficiency is by far the commonest pattern. 3. Other morphologies in peripheral smear usually indicates presence of additional risk factors for anemia like blood loss, iron deficiency and malnutrition. 4. Presence of such risk factors is associated with significant reduction in mean haemoglobin values. 5. This suggests need for treatment of iron deficiency and correction of other anaemic risk factors in chronic renal disease. 6. Diabetic nephropathy is the commonest aetiology of chronic renal failure