The haematological pattern of the patients with chronic kidney disease in a tertiary care setup in south India

Background: With the incidence and the prevalence of chronic kidney disease (CKD) increasing worldwide and its economic repercussions, a detailed haematological workup of such patients is necessary to detect the type of anaemia, as there is a general tendency to consider anaemia to be of the normocytic normochromic type. However in India, a co-existing iron deficiency is also common. Anaemia is an independent risk factor for the mortality in patients with chronic kidney disease. Platelet dysfunction is inherently associated with the uraemic environment, and bleeding tendencies may be manifested despite the presence of normal platelet counts, due to defects in the platelet functioning. This can be detected by the prolonged bleeding times. The immunosuppressed state which is seen in chronic kidney disease is due to defects in both the cell mediated and the humoral immune systems and also due to the associated complement dysfunction. Objective: This study was chosen as an attempt towards detecting the various aspects which are associated with anaemia and its relationship with the stage of chronic kidney disease, in addition to other haematological changes which occur in the same. Materials and Methods: This observational study included 100 patients of chronic kidney disease, who were included, irrespective of their age, sex, aetiology and their clinical profiles. A thorough clinical examination and evaluation were conducted, which included serum iron studies. By using Chisquare analysis, the parameters which were used for a statistical correlation were the levels of anaemia with respect to the stages of the kidney disease, the type and the severity of anaemia, thrombocytopaenia with the bleeding time, leucocytosis and elevated ESR values. Results: Although most of the anaemia was of the normocytic type, nearly a third of the patients had microcytic hypochromic and a mixed type of anaemia. Those with a microcytic hypochromic picture correlated with a severe degree of anaemia. The elevated Erythrocyte Sedimentation Rate (ESR) levels were more distributed in the lower levels of the Glomerular Filtration Rate (GFR). There was no association between the platelet levels and the bleeding time. The leucocytosis was not necessarily associated with infections. Conclusions: It is pertinent to detect and treat subclinical iron deficiency in patients with CKD and to not over-investigate the minor haematological variations.