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Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

The Journal of Latvian Academy of Sciences

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Renal anaemia: the role of haemoglobin control in patients with chronic kidney disease

Viktorija Kuzema1, / Aivars Pētersons1, / Harijs Čerņevskis1, / Aivars Lejnieks1,

Rīga Stradiņš University, Dzirciema iela 16, Rīga, LV-1007, LATVIA1

Pauls Stradiņš Clinical University Hospital, Rīga, Pilsoņu iela 13, LV-1002, LATVIA2

Rīga Eastern Hospital, Hospital "Linezers", Rīga, LV-1006, LATVIA3

This content is open access.

Citation Information: Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.. Volume 64, Issue 3-4, Pages 137–143, ISSN (Print) 1407-009X, DOI: 10.2478/v10046-010-0027-4, January 2011

Publication History

Published Online:
2011-01-25

Renal anaemia: the role of haemoglobin control in patients with chronic kidney disease

Chronic kidney disease (CKD) is a significant and prevalent health problem in the world. Anaemia is one of the most common manifestations in patients with CKD. The correction of anaemia with erythropoietin normalises haemoglobin level and improves quality of life. Many aspects of the impact of anaemia treatment with erythropoiesis-stimulating agents on the progression of CKD remain unresolved and disputable. The present study is a retrospective chart review of 1654 outpatients with CKD. The data were collected from the Centre of Nephrology between 1 January 2002 and 31 December 2006. The aims of the study were to assess the causes of CKD; the prevalence of anaemia based on the current guidelines for anaemia management in CKD (Kidney Disease Dialysis Outcomes Quality Initiative; K/DOQI); to evaluate haemoglobin (Hb), systolic and diastolic blood pressure (SBP and DBP), glomerular filtration rate (GFR) at the first referral to a nephrologist and at the start of renal replacement therapy (RRT). The most common causes of CKD were arterial hypertension (17.2%), chronic glomerulonephritis (17.2%), chronic intersticial nephritis (13.3%), and diabetes (12.8%). Twenty-three percent of end-stage renal disease (ESRD) patients had diabetes mellitus. At the first visit in the renal department, 16% of the patients had an advanced degree of CKD (GFR <30 ml/min). The proportion of patients under an observation in the kidney centre for a period of six months and more was only 34% (554 of 1654). Hypertension was recorded in 72% of study subjects. The blood pressure (BP) values in patients at the first visit (n = 1633) vs. at the start of RRT (n = 154) were: mean SBP 147.4 ± 24.8 mm Hg vs. 152.2 ± 23.0 mm Hg (P < 0.05); mean DBP 88.8 ± 13.6 mm Hg vs. 88.4 ± 12.0 mm Hg (P 0.05). Anaemia was recorded in 41% of study subjects, estimated using K/DOQI recommendations. The prevalence of anaemia was increased from 30.2% to 44.8% of study patients with a rise of BP (from normal BP to hypertension; P < 0.05). The mean Hb level at the start of RRT was 9.8 ± 2.1 g/dl. Only 18% of patients with renal anaemia had used erythropoiesis-stimulating agents before RRT (28 of 155). Anaemia is the prevalent condition at moderate degrees of CKD. The severity of anaemia in the CKD population is determined by evidence of diabetes, cardiovascular disease, and renal function. Anaemia may often be unrecognised or untreated.

Renālā anēmija: hemoglobīna līmeņa noteikšanas nozīme slimniekiem ar hronisku nieru slimību

Hroniska nieru slimība (HNS) ir nozīmīga sabiedrības veselības problēma pasaules mērogā. Anēmija ir viena no biežākām HNS izpausmēm. Anēmijas ārstēšana ar eritropoēzi veicinošiem medikamentiem labvēlīgi ietekmē HNS attīstību, slimnieka dzīves kvalitāti un sirds un asinsvadu sistēmu. Darbā ir retrospektīvi analizēti 1654 slimnieki ar HNS (P. Stradiņa Klīniskās universitātes slimnīcas Nefrologijas centra arhīva materiāli no 2002. līdz 2006. gadam). Pētījuma mērķis bija izpētīt HNS pamatcēloņus, HNS slimnieku novērošanas ilgumu, arteriālās hipertensijas biežumu, anēmijas biežumu, smagumu un ārstēšanas iespējas slimniekiem ar HNS. Saskaņā ar ASV vadlīnijām par anēmijas ārstēšanu HNS slimniekiem (KDOQI 2006) anēmijas diagnoze bija ticama, ja hemoglobīna (Hb) līmenis bija <13,5 g/dl vīriešiem un <12,0 g/dl sievietēm. Pētījuma rezultāti liecina, ka visbiežākie HNS cēloņi bija hipertensīvā nefropātija (17,2%), hronisks glomerulonefrīts (17,2%), hronisks intersticiāls nefrīts (13,3%), cukura diabēts (12,8%). Bez tam cukura diabēts kā terminālas nieru mazspējas cēlonis bija 23% slimnieku ar nieru aizstājterapiju (NAT). Pirmā vizītē 16% slimniekiem tika konstatēta progresējoša nieru slimība (glomerulu filtrācijas ātrums <30 ml/min). Pētījuma rezultāti liecina, ka tikai 34% (554 no 1654) analizēto slimnieku bija regulāra ilglaika (>6 mēneši) ambulatoriskā novērošana pie nefrologa. Arteriālā hipertensija tika konstatēta 72% dalībnieku. Vidējais asinsspiediens pētījuma slimniekiem pirmajā vizītē (n = 1633) vs. NAT sākšanas brīdī (n = 154) bija šāds: vidējais sistoliskais asinsspiediens (SAS) - 147,4 ± 24,8 mm Hg vs. 152,2 ± 23,0 mm Hg (p <0,05); vidējais diastoliskais asinsspiediens (DAS) - 88,8 ± 13,6 mm Hg vs. 88,4 ± 12,0 mm Hg (p >0.05). Saskaņā ar ASV rekomendācijām par anēmijas diagnostiku un ārstēšanu, anēmija tika konstatēta 41% analizēto slimnieku. Anēmijas biežums korelē ar arteriālo hipertensiju: no 30,2% slimniekiem ar normālu arteriālo asinsspiedienu līdz 44,8% dalībniekiem ar hipertensijas 2. pakāpi (P < 0,05). Vidējais Hb līmenis, sākot NAT, bija 9,8 ± 2,1 g/dl. Vidējais Hb līmenis slimniekiem ar cukura diabētu bija ticami zemāks nekā slimniekiem ar citu HNS pamatpatologiju. Eritropoetīnterapijas lietošana pirmsdialīzes periodā tika konstatēta tikai 18% HNS slimnieku ar anēmiju. Anēmija ir viena no biežākām HNS klīniskām izpausmēm HNS slimniekiem. Anēmijas biežumu un smagumu nosaka blakus slimības (piem., cukura diabēts, sirds asinsvadu sistēmas slimības) un nieru funkcija (HNS stadija). Anēmija bieži vien netiek diagnosticēta un ārstēta.

Keywords: chronic kidney disease; anaemia; erythropoietin

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