Profile of anemia in chronic renal failure patients: comparison between predialyzed and dialyzed patients at the Division of Nephrology, Department of Internal Medicine, Sanglah Hospital, Denpasar, Bali, Indonesia.

AIM: To explore the profile of anemia in pradialytic and dialytic CRF patients at the Division of Nephrology, Department of Internal Medicine, Sanglah Hospital, Denpasar, from January to June 2000. METHODS: There were 26 chronic dialyzed patients and 26 pradialyzed patients. Technicon H-1 was used to examine peripheral blood count; blood urea nitrogen and serum creatinine were examined using standard technique. MEIA (microparticle enzyme immunoassay) was used for serum folic acid and serum B12 level. RESULTS: Of 52 CRF patients, hemoglobin (Hb) levels ranged from 4.6 g/dl to 15.1 g/dl with a mean of 9.3 +/- 2.7 g/dl. Hematocrit levels ranged from 15.3% to 49.3%, with a mean of 29.8 +/- 7.9%. There was a significant difference in the hemoglobin and hematocrit levels of chronic dialyzed and pradialyzed patients. The prevalence of anemia (according to the WHO's criteria) among CRF patients was 84.5% (45/52), with the prevalence in chronic dialyzed patients being 100% and 73.1% in pradialyzed patients. If a hemoglobin level of less than 10 g/dl is used as a cut off point, the prevalence of anemia in dialyzed patients was 96.2% and 30.8% among pradialyzed patients. The severity of anemia among 26 dialyzed patients was: severe in 2 cases (8%), moderate in 16 cases (64%) and mild in 7 cases (28%), while in pradialytic patients the severity of anemia was: moderate in 4 patients (50%) and mild in 4 (50%). The morphology of 33 anemic patients was normocrhomic normocytic in 26 (78.8%) cases, slightly macrocytic in 7 (21.2%) cases, and no hypochromic anemia was found. Two anemic patients were associated with low serum folic acid (1 patient with macrocytic anemia and the other case with normochromic normocytic anemia). The serum B12 level was found to be normal in all cases. There was no significant correlation between the severity of anemia and serum creatinine levels or duration of hemodialysis. CONCLUSION: Anemia is a hallmark for CRF patients with a high prevalence of anemia and moderate degree of anemia. Most of anemic cases were normochromic normocytic. Loss of renal mass could be the principle mechanism. In a small proportion of patients, folic acid deficiency may be the cause of anemia. In this study, iron deficiency anemia was not likely an important factor since no hypochromic anemia was found.

Relationship between creatinine clearance and plasma homocysteine levels in predialytic chronic renal failure patients.

In order to determine the relationship between homocysteine levels and renal function, a cross-sectional study was carried out at out-patients clinic division of Nephrology and Hypertension Sanglah General Hospital Denpasar. Patients selected for the study were those with creatinine levels of 1.5-8.0 mg/dl aged 18 to 60 years. All eligible patients were examined for serum creatinine levels. At the same time blood samples were drawn for the examinations of total fasting Homocysteine levels. Creatinine clearance was calculated by Cockcroft-Gault formula, serum creatinine levels were examined by Jaffe method and total fasting Homocysteine levels were examined by fluorescence polarization immunoassay method (FPIA) method. If fasting plasma homocysteine levels were correlated with some related factors including creatinine clearance, reciprocal creatinine levels, age and gender, it was shown that only age (r=0.39, p=0.04) and creatinine clearance (r=0.39, p=0.04) had moderate and significant correlation with homocysteine levels. If both creatinine clearance and age as independent factors were correlated with fasting plasma homocysteine levels using multiple regression analysis, it was shown that both variable had strong (r=0.5) and significant relationship (p=0.03), yielding regression equations: Hcy (mmol/L) = -0.20 Cct (ml/mnt) + 0.21 age (ys) + 12.8. In conclusions, in patients with pre-dialytic chronic renal failure both creatinine clearance and age are strong predictors to plasma homocysteine levels.