“Iron status in patients with end stage renal disease on chronic hemodialysis at Rwanda Military Hospital and King Faisal Hospital, Kigali: Prospective descriptive cross-sectional study”

Abstract

Background Chronic kidney disease is a condition associated with a high rate of anemia as renal function declines. The anemia worsens is due to the insufficient production of erythropoietin. However, other causes of anemia such as iron deficiency were found to be linked with CKD. Before the anemia correction, it is important to know the iron status to improve the anemia treatment modalities. Objectives: to assess the iron status of patients with ESRD on chronic hemodialysis at RMH and KFH using serum iron and serum ferritin, in addition to FBC as laboratory parameters. Methods: This was a cross sectional study. Over a period of 5 months from 1st January 2021 to 31st May. In this period, we recruited 74 patients aged 18 years and above with ESRD on chronic hemodialysis at Rwanda military hospital and King Faisal hospital, Kigali. We recorded all patients’ demographics, date of starting their first hemodialysis session, history of blood transfusion and other use of medications notably iron and erythropoiesis stimulating agents. The samples were collected and sent to laboratory for FBC and iron studies (serum iron and serum ferritin levels). Results: Seventy-four patients with ESRD on chronic hemodialysis were recruited in this study with mean age 51(19-77) with iron deficiency anemia and 63(43-84) with non-iron deficiency anemia. The male to female ratio was2:1 P value <0.001. The mean hemoglobin level for all participants was 9.59 g/dl  1.93 (SD). The desired HB being at least,11g/dl recommended by KDIGO guideline for patients with ESRD on chronic hemodialysis which was achieved by only 17 patients (23%) and the prevalence of anemia in our population of patients on chronic hemodialysis at KFH, and RMH was 77%. Low iron status was observed in 62% (46) of the study population by using serum iron marker as criteria, whereas by using serum ferritin marker as criteria low iron status was met by 35% (26) participants. Iron and EPO supplement was adequately supplied in patients with Iron deficiency anemia with 98.4% (62) of IDA patients on both parenteral IV iron and EPO, P value <0.001. Notably, the long duration of iron and EPO therapy defined by 6 months in this study was

associated with less incidence of developing IDA ,20.27% in IDA compared to 33.8 % in non-IDA, P value:0.011. Conclusion: Iron deficiency anemia is highly prevalent and a major contributor of anemia in patients with ESRD on chronic hemodialysis at RMH and KFH dialysis units. Long duration of iron supplement and EPO use is associated with low occurrence of IDA. Assessment of iron status before and after starting iron therapy for our patients on chronic hemodialysis as per K/DIGO guidelines, is important to limit the prevalence of IDA.