Anemia Prevalence Greater in Mexican Patients on Hemodialyis

Juan Carlos Hernandez Rivera, MD

The prevalence of anemia in patients with chronic kidney disease (CKD) on hemodialysis (HD) was found to be higher in a cross-sectional study in Mexico City than in other large population studies, but with the same contributing factors.

Juan Carlos Hernández Rivera, MD, Department of Nephrology, Mexican Institute of Social Security (IMSS), Mexico City, and colleagues ascertained prevalence and related factors in a population treated in Mexico City, and compared their findings to those from other large studies.

"On account of its high frequency, its impact on the patients' quality of life, and mainly because it is susceptible to intervention, the control of anemia is considered a quality-of-care indicator and has been included in international studies such as Dialysis Outcomes and Prescription Patterns Study (DOPPS) as an evaluation criteria," Rivera and colleagues wrote.

Although these large international studies have contributed to establishing the reference values associated with favorable clinical outcomes, Rivera and colleagues note that only developed countries participate in these studies. "Nevertheless, its extension to developing countries is also highly important," they asserted.

The investigators analyzed the medical records of 747 patients with CKD on HD in the northern metropolitan area of Mexico City who were receiving treatment as of December 31, 2019. Patients were excluded from the study if they were receiving less than 3 HD sessions per week, or presented with chronic or acute infectious disease at the beginning of the HD program.

Also excluded were pregnant patients and patients with bleeding history within 3 months prior to the study.The most frequent etiology for CKD was diabetes mellitus (24.9% of patients) and arterial hypertension (16.3%); with primary glomerulopathies implicated in 5.5%.

With reference to the WHO definition and the KDIGO Clinical practice Guideline for Anemia in Chronic Kidney Disease specifying anemia with hemoglobin (Hb) levels of <13 g/dL in men and <12 g/dL in women, 94.2% (n = 676) of the study population was anemic.The investigators contrast that prevalence to the approximate 70% of Stage 5 CKD patients in other studies.In the Mexico City population, the mean Hb was 9.7 g/dL; and the mean corpuscular volume (MCV) mean was 92.29 fl.

In this study, Rivera and colleagues stratified patient datainto 2 groups, below and above 10g/dl Hb.With this cut-off, they determined that patients with lower levels were older, had higher phosphorous and lower iron levels. With further analysis, they determined that risk factors for Hb <10 g/dL included male gender, diabetes, hyperphosphatemia, higher calcium-phosphate product and iron deficiency. Protective factors included female gender, glomerulopathies, hypophosphatemia, and serum ferritin >500ng/dl.

Rivera and colleagues point out several quantitative differences in anemia-related factors from large population studies, including those from the GGC-DOPPS (Gulf Cooperation Council—Dialysis Outcomes and Practices Patterns Study).The Mexico Citycohort had lower Hb levels and lower iron-status indicators such as ferritin and transferrin saturation, and required higher doses of erythropoetin (EPO).They also noted that the GCC-DOPPSreported broader prescribing of erythropoiesis stimulating agents, higher IV iron doses and lower oral iron use.

"Periodic studies such as the one...are necessary to detect improvement opportunities in the quality of care to decrease morbidity and mortality in HD patients," Rivera and colleagues concluded.

The study, "Factors Related to the Presence of Anemia in Patients with Chronic Kidney Disease in Hemodialysis," was published online in Annals of Hematology & Oncology.