A cross-sectional study of anemia in patients with stage3a-5D CKD at high altitude / 中国实用内科杂志

ABSTRACT

OBJECTIVE:s To investigate the prevalence, clinical features, risk factors and treatment of anemia in patients with stage3 a-5 D CKD at high altitude. METHODS: A total of 525 patients with stage3 a-5 D CKD admitted to Diqing Tibetan Autonomous Prefecture People's Hospital between Nov.2017 and Nov.2018 were enrolled in this cross-sectional study, and then categorized into 5 groups according to eGFR and whether depending on dialysis. Clinical and laboratory data were collected and analyzed to study the prevalence, clinical features, risk factors as well as the treatment of anemia in these CKD patients.RESULTS: Among 525 patients with stage3 a-5 D CKD(average age59.2 ± 15.4 ys,CKD stagingstage3 an = 269;stage3 bn=113;stage4n=56;stage5n=36;stage5 Dn=51),anemia was established in 233(44.4%)patients, 68.2% of which had mild anemia. The prevalence of anemie was 29%,33.6%64.3%,88.9% and 96.1,respectively from stage 3 a to stage 5 D, and the prevalence increased and the severity of anemia deteriorated with CKD progression, along with other clinical parameters including serum creatinine, albumin, uric acid,MDRD-eGFR, and calcium and phosphorus metabolism. Logistic regression analysis showed that advanced CKD stage(OR=2.206,P<0.001), hypoalbuminemia(OR=0.919,P=0.034), lower BMI(OR=0.868,P=0.012)and low serum calcium(OR=0.062,P=0.019)were independent risk factors for anemia in CKD patients at high altitude. Among 233 patients with anemia, only 37.7% had ever received treatment for anemia and the average hemoglobin concentration when initiating the treatment was(79.9±19.3)g/L. Erythropoietin was not widely used and the target-achieving rate was only 37.5%(33/88).CONCLUSION:s The prevalence of anemia increases with CKD progression in CKD patients at high altitude. Advanced CKD stage, hypoalbuminemia, lower BMI and low serum calcium are independent risk factors for anemia. The general situation of treatment for anemia is not good,with late starting time of treatment and low treatment rate,low rate in EPO use and low target-achieving rate,which should be paid affention to.