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Year : 2014  |  Volume : 3  |  Issue : 2  |  Page : 85-97

Assessment of hematological and biochemical parameters in hemodialysis patients and the impact of hemodialysis duration on hepcidin, ferritin and CRP

1 (Hematology), consultant hematopathologist, and lecturer / Department of Pathology, College of Medicine, University of Baghdad
2 Hematopathologist, Al-Hussain Teaching Hospital

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Source of Support: None, Conflict of Interest: None

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Background: Hemodialysis is the most common method used to treat advanced and permanent kidney failure. Anemia in end stage renal disease is almost universal. It can be caused by erythropoietin deficiency, blood loss, iron deficiency, shortened red cell life span, vitamin deficiencies, the "uremic milieu," and inflammation. Chronic inflammation plays an important role in the disease process and high levels of inflammatory markers like hepcidin, which mediates the anemia of inflammation, appear to accompany reduced renal function. Serum ferritin is an acute phase reactant and thus may also be elevated in inflammation. Objectives: The aim of study was to compare the hematological parameters in patients on hemodialysis and display the correlations between the duration of hemodialysis and hemoglobin, erythrocyte sedimentation rate, C-reactive protein, hepcidin and ferritin. Patients and methods : This is a case control study. It was conducted at Al-Hayat center for hemodialysis at Al-Karama hospital, and included 60 adult patients with documented end stage renal disease on hemodialysis. The frequency of hemodialysis was 2-3 times/week. Also 20 healthy individuals were recruited as control group. Estimation of complete blood counts, erythrocyte sedimentation rate, biochemical parameters, C-reactive protein and hepcidin were done Results : The majority of patients (70%) were > 45 year old, and the male: female ratio was 2.8:1. The mean hemodialysis duration was 18.6 ± 2.5 months (range: 1 -120 months), and 70% of patients were on hemodialysis for > 11 months. There was statistically significant decrease of absolute lymphocyte count, RBC count, hematocrit, hemoglobin and platelet count (p <0.05), and a significant increase of red cell distribution width levels in patients than controls (p<0.05). A significant higher levels of blood urea and serum creatinine (p < 0.001), and lower levels of albumin, iron, transferrin and TIBC were found in patients than control (p << 0.003). The mean serum hepcidin, ferritin, C-reactive protein and erythrocyte sedimentation rate were significantly higher in patients than control (p < > 0.005). There was a significant difference in mean CRP when compared with ferritin cutoff level of 800 ng/ml (p<0.009). There were slight increase in the levels of ESR, CRP, Hb, hepcidin, and ferritin with increased duration of hemodialysis but were all found to be statistically insignificant (p>0.05). Conclusions: Anemia and low mean absolute lymphocyte count and serum albumin level; all predict poor survival in HD patients. End stage renal disease patients had high levels of inflammatory markers which showed slight insignificant increase with the duration of hemodialysis.

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