Anemia is a global public health problem affecting both developing and developed countries with major consequences for human health as well as social and economic development.
Chronic kidney disease (CKD) is a prevalent, worldwide condition, and the number of patients affected continues to increase. Globally, it is estimated that, by 2010, >2 million people will be afflicted with CKD. Although the most severe form of CKD is kidney failure and the need for renal replacement therapy [hemodialysis (HD), peritoneal dialysis, or renal transplantation], many more patients are affected by less severe forms of CKD.
The incidence and prevalence of CKD have increased in recent years in both developed and developing countries. The prevalence of earlier stages of CKD, while relatively stable at 14.8%, implies that an estimated 30 million American adults have CKD, with millions of others at increased risk. In 2015, there were 124,111 new cases of ESRD reported, with a total of nearly 500,000 patients receiving maintenance dialysis treatments and well over 200,000 living with a kidney transplant.[3,4]
There is no published study done on burden of anemia among chronic kidney patients in Ethiopia. Therefore, the aim of this retrospective study is to assess the magnitude and associated factors of anemia among chronic kidney patients attending St. Paulo’s Hospital Millennium Medical College Hospital. As anemia is a hematological disorder, diagnosis, treatment, and prevention are very important. Hence, the results of this study, if further explored, benefit the chronic kidney patients for diagnosis, treatment, and prevention purpose.
This study could provide information on the pattern of anemia as well as associated factors among CKD patients. It might be useful for health managers and planners to develop appropriate preventive services, allocate resources, decide on priorities, and target certain populations.
Study area and period
The study was conducted at St. Paulo’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. The hospital was established in 1878. The center was established in 2016 in collaboration with U-M and the hospital in Addis Ababa which gives kidney transplant and HD treatment. The data collection period was conducted from May 22, 2018, to May 29, 2018.
A hospital-based retrospective cross-sectional study was designed and was conducted.
Dependent variable: anemia (yes/no). Independent variables: Age, sex, residence, diabetic status, and hypertension (HTN).
Source population: All CKD patients receiving patient follow-up care at St. Paulo’s Hospital Millennium Medical College.
Study population: All CKD patients who attended from March 2016 to April 2018 at St. Paulo’s Hospital Millennium Medical College.
Inclusion and exclusion criteria
All individuals who visited at renal outpatient department unit and were diagnosed for CKD with full data during the study period were included in this study. CKD patients with incomplete data and those patients in dialysis were excluded from this study.
Data were collected by using data collection format developed for this purpose. Complete data: age, sex, residence, blood pressure (BP) status, and diabetic status were collected from a patient medical record book.
Anemia: it is reported as low hemoglobin (Hb) value (Hb <13.5 g/dL for males and Hb <12 g/dL for females).
CKD: it is gradual loss of kidney function. Diabetic: metabolic disease characterized as high blood glucose level (fasting glucose level >126 mg/dL).
Hypertension: it is reported as high BP with systolic BP is 140–159 or above and diastolic BP is 85–89.
Ethical clearance was obtained from Ethical Review Committee of Addis Ababa University College of Health Science. Then, the formal letter of cooperation was written to St. Paulo’s Hospital Millennium Medical College, and we got permission to retrieve the data. Only given codes were used to each patient’s data to keep confidentiality.
Data were entered into IBM SPSS Statistics version 20.0 (IBM Corp., Armonk, NY, USA), and descriptive statistics were analyzed using the software. Chi-square test was done to determine the simple association of variables with anemia. P <0.05 was taken as a statistically significant association.
A total of 352 CKD patients were included in this study. 56.82% (200) of them were male and 43.185 (152) were female. Majority of the study participants (25.28%) were in the age group of 49–58 years. 53.41% (188) of the study participants are living in an urban area. 53.13% (187) of the patients are diabetic and 57.10% (201) are with HTN (Table 1).
From 352 CKD patients, 65.91% (232) were found anemic (Figure 1).
From anemic patients, 33.91% (119) were diabetic and 36.36% (128) were with HTN. The residence-specific prevalence of anemia was higher in rural 35.23% (124) than urban 30.28% (108), and there is a statistically significant association with anemia (P = 0. 023) (Table 2).
This study is done in a single kidney transplant center, and the total cases are relatively low which could be considered a limitation to this study. In this study, the prevalence of anemia was 65.91% among 352 patients with CKD. This prevalence is high compared to a study reported in the USA which is 47.7% prevalence of anemia. The differences could be due to differences in geographical location, lifestyle difference of the people, and genetic difference.
A study conducted in the United Kingdom by Annear et al at St. Georges Hospital reported that the prevalence of anemia among CKD patients was 9.2% which is much lower than the prevalence in our study. This possible justification could be different lifestyles and socioeconomic status of the people since Ethiopians are under developing countries.
Another study done in Indonesia showed that the prevalence of anemia was 84.5% among CKD patients. This study was done using 52 CKD patients on dialysis which could be the reason for high prevalence of anemia compared to our study. The severity of CKD may increase the occurrence possibility of anemia.
A cross-sectional study conducted by Emem et al in Nigeria reported that the prevalence of anemia was 87% among 39 CKD patients. This study shows a higher prevalence than our study result which could be due to using small number of participants.
However, in West Ethiopia, the prevalence of anemia among kidney disease patients has been reported to be 14%. They assess the prevalence in all kidney patients which could be the reason why it is low prevalence of anemia. Our study participants were chronic kidney patients.
There is a high prevalence of anemia among chronic kidney patients which is 65.91% among CKD patients at St. Paulo’s Millennium Medical College Hospital. There is no statistically significant association between anemia and sociodemographic characteristics, but residence of patients has a statistically significant association with anemia.
Conflict of interest:
1. Soliman AT, De Sanctis V, Yassin M, Wagdy M, Soliman N. Chronic anemia and thyroid function. Acta Biomed 2017;88:119–27
2. Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney Int 2011;80:1258–70
3. Saran R, Robinson B, Abbott KC, et al. US renal data system 2017 annual data report: Epidemiology of kidney disease in the United States. Am J Kidney Dis 2018;71:A7.
4. Abd ElHafeez S, Bolignano D, D’Arrigo G, Dounousi E, Tripepi G, Zoccali C. Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: A systematic review. BMJ Open 2018;8: e015069
5. Kalantar-Zadeh K, Block G, Humphreys MH, Kopple JD. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int 2003;63:793–808
6. Bodnar LM, Scanlon KS, Freedman DS, Siega-Riz AM, Cogswell ME. High prevalence of postpartum anemia among low-income women in the United States. Am J Obstet Gynecol 2001;185:438–43
7. Annear NM, Banerjee D, Joseph J, Harries TH, Rahman S, Eastwood JB. Prevalence of chronic kidney disease stages 3-5 among acute medical admissions: Another opportunity for screening. QJM 2008;101:91–7
8. Suega K, Bakta M, Dharmayudha TG, Lukman JS, Suwitra K. Profile of anemia in chronic renal failure patients: Comparison between predialyzed and dialyzed patients at the division of nephrology, department of internal medicine, Sanglah Hospital, Denpasar, Bali, Indonesia. Acta Med Indones 2005;37:190–4
9. Emem CP, Arogundade F, Sanusi A, Adelusola K, Wokoma F, Akinsola A. Renal disease in HIV-seropositive patients in Nigeria: An assessment of prevalence, clinical features and risk factors. Nephrol Dial Transplant 2008;23:741–6
10. Fiseha T, Adamu A, Tesfaye M, Gebreweld A. Prevalence of anemia in diabetic adult outpatients in Northeast Ethiopia. PLoS One 2019;14: e0222111