A Study To Assess Changes in The Hematological Profile in Chronic Kidney Disease

The Pharma Innovation Journal 2015; 4(6): 01-03
ISSN: 2277- 7695

TPI 2015; 4(6): 01-03 A study to assess changes in the hematological profile in
© 2015 TPI
www.thepharmajournal.com chronic kidney disease
Received: 02-06-2015
Accepted: 04-07-2015
Sneha V George, JoJo K Pullockara, Kumar Sai Sailesh, Mukkadan J K.
Sneha V George
PG student, Department of
Physiology, Little Flower Abstract
Institute of Medical Sciences and Chronic kidney disease is a condition that affects kidney functions and if untreated, causes kidney failure.
Research. The aim of the study was to assess the hematological changes in chronic kidney disease of the patients.
50 chronic kidney disease patients were recruited for the present study by using convenience sampling
JoJo K Pullockara technique. Data was collected from the medical records. It was observed that the main cause for Chronic
Nephrologist, Little Flower kidney disease is type 2 diabetes mellitus in 90% cases, systemic hypertension in 86% cases, coronary
Hospital and Research Centre, artery disease in 72% cases, renal calculi in 30% cases and acute pyelonephritis in 4% cases. Our study
Angamaly. agrees with the previous studies as we have observed significant decrease in the PCV and hemoglobin
levels and increase in TLC, platelet count in patients with chronic kidney disease. We have observed that
Kumar Sai Sailesh
normocytic normochromic anemia is most common anemia in CKD patients. Further it was observed that
Asst. Professor, Department of
Physiology, Little Flower
type 2 diabetes mellitus and systemic hypertension are more common causes for CKD. From the present
Institute of Medical Sciences and study, it may be concluded that anemia is the most common hematological changes in CKD patients.
Research. However, we recommend further detailed study in this regard to confirming the results.
Dr. J K Mukkadan. Keywords: Chronic kidney disease, Hematological changes

Research Director, Little Flower
Medical Research Centre, 1. Introduction
Angamaly. Chronic kidney disease is a major health problem throughout the world. It is a global public
health problem, with a greater burden and very high cost of care especially in developing
countries [1]. In 1990 death due to chronic kidney disease is 409,000 and it has increased to
956,000 in 2013 [2]. Chronic kidney disease is identified by a blood test for creatinine. Higher
levels of creatinine indicate a lower glomerular filtration rate and, as a result a decreased
capability of the kidneys to excrete waste products [3]. The present study was undertaken to
study the hematological changes in chronic kidney disease.
Methodology
The study was approved by Institutional Ethics Committee. A written, informed consent was
obtained from all the participants. The study was performed in accordance with the “Ethical
Guidelines for Biomedical Research on Human Participants, 2006” by the Indian Council of
Medical Research and the Declaration of Helsinki, 2008.
Study design
Cross-sectional study
Participants, Inclusion and exclusion criteria

50 chronic kidney disease patients (35 males and 15 females) admitted in nephrology
department of our hospital were recruited for the present study. The following criteria were
used to recruit the patients.
Inclusion criteria
1. Patients with end-stage renal failure on renal replacement therapy in the form of
hemodialysis and peritoneal dialysis.
Correspondence:
Dr. J K Mukkadan
Research Director, Little Flower
Exclusion criteria
Medical Research Centre, 1. Pregnant women, hematological malignancy, renal transplantation patients were excluded
Angamaly. from the study.
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Methods Discussion
On admission, patients were subjected to complete physical It was reported that Uremia interferes with erythropoiesis,
examination and laboratory investigations of Hemoglobin, granulocyte, platelet, and immune functions. As a result,
Total leucocyte count, packed cell volume, peripheral blood uremic patients are almost invariably anemic, and have a high
smear and blood urea and serum creatinine by standard incidence of infections and hemorrhagic complications [4].
methods at our hospital. Data was collected from case sheet of Many of the abnormalities described in acute or chronic renal
the patients from the medical records department. failure appear to be directly related to accumulation of uremic
toxins, particularly those in the middle molecular range and
Data analysis: Data was analyzed by SPSS 20.0. may respond to dialysis treatment [5].
Suresh M et al., reported that Chronic renal failure patients
Results have lower hematological indices, due to impaired production
2% of chronic kidney disease was in the age group of 21 – 30 of erythropoietin, and other factors like increase hemolysis,
years, 10% were in the age group of 31 – 40 years, 12% were suppression of bone marrow erythropoiesis, hematuria and
in the age group of 41 – 50 years, 16% were in the age group gastrointestinal blood loss. The concentration of serum
of 51 – 60 years, and 60% were in the group of above 61 creatinine shows negative correlation with all the
years. 0 – 6 gm % of hemoglobin was found in 6% cases, 7 – hematological parameters. And the degree of changes depends
10 gm % was found in 72% cases and above 10 gm % was on the severity of renal failure [6].
found in 22% cases. 17 patients were having blood urea level It was reported that Normochromic normocytic anemia is the
between 50 – 90 mg/dl, 18 were having between 91 – 130 mg / most common hematological abnormality in chronic renal
dl, 6 were having between 131 – 170mg /dl and 9 were having failure. Anemia can be correlated with severity of renal failure.
above 171 mg / dl. 6 % cases were having 0 – 2.0 mg/dl, 18 Higher the blood urea the severe is the anemia [7]. Naghmi Asif
cases were having 2.1 – 4.0, 14 cases were having 4.1 – 6.0, 9 et al., reported that among hematological parameters
cases were having between 6.1 – 8.0 and 6 cases were having hemoglobin is the most commonly affected [8].
above 8.1 mg / dl. Afshan Zeeshan Wasti et al., reported that mean of RBCs, Hb
and PCV were significantly lowered in chronic kidney disease
Table 1: Description of systemic disease associated with chronic
patients and similarly MCH and MCHC indices also decreased
kidney disease (n=50)
significantly [9].
Disease Frequency Percentage (%) It was reported that CRF patients with anemia had lower
Diabetes mellitus 45 90 hematological indices and the degree of changes depend on the
Hypertension 43 86 severity of renal failure [10]. Our study agrees with the previous
Coronary artery disease 36 72 studies as we have observed significant decrease in the PCV
Renal calculi 15 30 and hemoglobin levels and increase in TLC, platelet count in
Acute pyelonephritis 2 4 patients with chronic kidney disease. We have observed that
normocytic normochromic anemia is most common anemia in
Table 2: Distribution of Total leukocyte count in chronic kidney
disease patients (n=50)
CKD patients. Further, it was observed that type 2 diabetes
mellitus and systemic hypertension are more common causes
TLC in thousands/cumm Frequency Percentage (%) for CKD.
4.1-6.0 6 12
6.1-8.0 6 12 Limitations and future perspectives
8.1-10 13 26 The major limitation of the present study was less sample size.
10.1-12 6 12 Also, we have not studied male and female comparison. In our
>12 19 38
future studies, we plan a multi-centered study with study with
Table 3: Distribution of platelet count in chronic kidney disease
higher sample size to confirm the results and also to observe
patients (n=50) male and female differences.
Platelet count in lakhs Frequency Percentage (%) Conclusion

<1 5 10 From the present study, it may be concluded that anemia is the
1.0-1.5 5 10 most common hematological changes in CKD patients.
1.5-2 9 18
However, we recommend further detailed study in this regard
>2 31 62
to confirming the results.
Table 4: Distribution of PCV in chronic kidney disease patients
(n=50) References
1. Jacobson LO, Goed Wasser E, Fried W, Plaza L. role of
PCV (%) Frequency Percentage (%) Kidney in Erythopoesis. 1957; 21:792.
10-20 2 4 2. Emersen CP Jr, Burrow BA. Mechanism of anemia and its
21-30 34 68 influence on renal function in chronic uremia. 1949;
31-40 13 26
144:518.
41-50 1 2
3. Callen IR, Limarzi LR. Blood and bone marrow studies in
renal disease. Am J Clin Path 1950; 20:325.
Table 5: Distribution of types of anaemia blood urea in chronic
kidney disease patients (n=50) 4. Fried W. Hematologic complications of chronic renal
failure. Med Clin North Am. 1978; 62(6):1363-79.
Type of anemia Frequency Percentage (%) 5. Hocking WG. Hematologic abnormalities in patients with
Normocytic normochromic 31 62 renal diseases. Hematol Oncol Clin North Am. 1987;
Microcytic hypochmic 15 30 1(2):229-60.
Macrocytic hypochromic 4 8
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6. Suresh M, Mallikarjuna reddy N, Sharan B Singh M, Hari

Krishna Bandi, Shravya keerthi G, Chandrasekhar M.
Hematological Changes in Chronic Renal Failure.
International Journal of Scientific and Research
Publication 2012; 2(9):1-4.
7. Sunita Rathod1 G, Arvind Ade K, Pravin Shekokar P. A
Study of Haematological Changes in Chronic Renal
Failure. Sch. J. App. Med. Sci. 2014; 2(4A):1232-1234.
8. Naghmi Asif, Sadaf Hasan, Khalid Hassan. Hematological
Changes in Patients of Chronic Renal Disease and Their
Response to Treatment with Erythropoietin. Int. j. pathol
2015; 13(1):14-19.
9. Afshan Zeeshan Wasti, Sumaira Iqbal, Naureen Fatima,
Saba Haider. Hematological disturbances associated with
chronic Kidney Disease and kidney transplant patients.
International Journal of Advanced Research 2013;
1(10):48-54.
10. Shaheda Khanam, Noorzahan Begum, Shelina Begum,
AMM Ehteshamul Hoque. Changes in Hematological
Indices in Different Stages of Chronic Renal Failure. J
Bangladesh Soc Physiol 2007; 2:38-41.
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The Pharma Innovation Journal 2015; 4(6): 01-03

ISSN: 2277- 7695

Dr. J K Mukkadan. Keywords: Chronic kidney disease, Hematological changes

Participants, Inclusion and exclusion criteria

Platelet count in lakhs Frequency Percentage (%) Conclusion

6. Suresh M, Mallikarjuna reddy N, Sharan B Singh M, Hari

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