Prevalence and risk factor of Anemia among Hemodialysis patient Prevalensi dan faktor risiko anemia pada pasien hemodialisis Al-Husayn Ali Jabbar Abd ali.ja@uokerbala.edu.iq Adult Nursing Department/College of Nursing/ University of Kerbala Iraq 21 02 2026 20022026 <bold id="_bold-16">Introduction</bold>

An irreversible reduction in kidney function that is severe enough to be fatal in the absence of dialysis or transplantation is referred to as renal failure. The National Kidney Foundation Kidney Disease Outcomes Quality Initiative classifies chronic kidney disease into five stages, with stage 5 referring to renal failure. This stage describes people with an estimated glomerular filtration rate of less than 15 mL per minute per 1.73 m2 body surface area or those who need dialysis regardless of glomerular filtration rate.(3) (4)

ESRD (End-stage renal disease) affects over 400,000 Americans, necessitates kidney transplantation or dialysis in order to survive. The only disease-specific Medicare program that provides coverage based on diagnosis to individuals of all ages is ESRD. In more than 4,500 institutions all over the United States in 2003, more than 340,000 people received dialysis treatments. Total Medicare expenses for the ESRD program were $17 billion in 2002, an 11% increase over expenditures in 2001. (6) (11)

A lower-than-normal hemoglobin concentration indicates anemia, which is caused by the circulation of fewer erythrocytes than is considered normal. As a result, less oxygen is being given to the body's tissues. Anemia is a symptom of underlying disorders rather than a unique disease condition. It is unquestionably the most prevalent hematologic disorder. Anemia comes in a variety of forms. Anemia is categorized using a physiological method based on whether the lack of erythrocytes is due to a problem with their generation (hypoproliferative anemia), their destruction (hemolytic anemia), or their loss (bleeding). (7)(8).

Chronic kidney disease (CKD) sometimes includes anemia, which is linked to worse outcomes. Recent clinical trials have shown increased morbidity and mortality linked to erythropoiesis stimulating drugs, raising questions about the current therapy of patients with anemia in CKD. Here, we look at recent discoveries regarding the molecular pathways underlying CKD-related anemia. These discoveries suggest new diagnostic procedures and therapeutic approaches that specifically target the pathophysiologic mechanisms producing this type of anemia. (1).

 <bold id="_bold-17">Methodology</bold>

To determine the prevalence and risk factors of anemia among hemodialysis patients in Imam Al-Hussein Medical City in Karbala city, a descriptive quantitative design is being used. was completed during the current study in order to fulfill the initial stated goals. The trial was started on February 3 and ran through February 15.

Data was gathered using a structured questionnaire with two parts: part I (demographic data) included fifteen (15) items, while part II (anemia prevalence questionnaire) had twenty-five (25) items. It was also obtained through interviews. Individual interviews with corona virus survivors were conducted in both urban and rural areas of Karbala. The interview takes each person between 10 and 15 minutes to complete.

The results of a pilot study and the computation of the alpha correlation coefficient were used to assess the questionnaire's accuracy. A committee of eight specialists from the Karbala University/College of Nursing will evaluate the questionnaire's reliability.

A non-probability (purposive) sample of (100) renal failure patients who had hemodialysis treatment and attended the Habib ibn Mozaher Al- Asaadi center between February 3 and February 15, 2019.

 <bold id="_bold-19">Results</bold> <bold id="_bold-20"> and Discussion</bold> Table (1): Distribution of hemodialysis patients that are participant in the study with their demographic characteristic.

Demographic Characteristic
Freq. % Cum. %
Age (per year) less than 20 4 4.0 4.0
21-30 year 14 14.0 18.0
31-40 year 14 14.0 32.0
41-50 year 21 21.0 53.0
51-60 year 21 21.0 74.0
more than 61 26 26.0 100.0
Gander Male 48 48.0 48.0
Female 52 52.0 100.0
Education Level Not read and write 26 26.0 26.0
Read and write 6 6.0 6.0
Primary 33 33.0 33.0
Medium 12 12.0 12.0
Preparatory 7 7.0 7.0
Institute 9 9.0 9.0
collage and more 7 7.0 7.0
Marital status Single 13 13.0 13.1
Married 73 73.0 73.7
Widowed 11 11.0 11.1
Separated 3 3.0 3.0
Duration of injury kidney failure less than 1 year 9.0 9.0 9
1-2 year 32.0 32.0 32
3-4 year 26.0 26.0 26
5 year and more 33.0 33.0 33
Total 100.0 100.0 100
Number of hemodialysis Weekly once a week 8 8.0 8.0
twice a week 34 34.0 42.0
three time a week 56 56.0 98.0
four time a week 2 2.0 100.0
Period of dialysis in each session 1-2 hours 2.0 2.0 2
3-4 hours 99.0 97.0 97
Father or mother suffer From anemia Yes 3 3.0 3.0
No 97 97.0 100.0
Father or mother suffer from thalassemia Yes 2 2.0 2.0
No 98 98.0 100.0
The weight loss in each Session 1-2 kg 42 42.0 42.0
more than 3 kg 56 56.0 98.0
3kg 2 2.0 100.0
BMI Before dialysis Under weight 5 50. 50.
Normal 0. 0.0. 0.0.
Over weight 60 600. 600.
Obesity 61 610. 610.
BMI after dialysis Under weight 0 001 00.
Normal 01 0101 0.0.
Over weight 0. 0.01 6.0.
Obesity 00 0001 660.

Freq. = Frequency. % = percentage. Cum. % = cumulative percent. M.S =mean of score

According to table (1) socio-demographic data, the majority of the study sample (26%) is within the age group of 61 years and older, and (52%) is female. (33%) of the sample's members only have a primary education. and are married (73%) in the study sample.

Additionally, the findings indicate that patients who participated in the study had hemodialysis for an average of more than 5 years.

The findings indicate that more than half of the study participants lost more than 3 kg of weight during each session. the frequency (56%) and the outcome (56).

The study demonstrates that more than half of the participants had normal BMIs prior to starting hemodialysis, with results of (60), (60%) and (70%) respectively. It also demonstrates that the result after hemodialysis was normal, with results of (70) and (70%) respectively.

According to table (1), the majority of sick parents do not have anemia. The frequency was (97%) and the outcome was (97). and also demonstrate that the majority of patients' parents are not thalassemia. the frequency was (98%) and the outcome was (98).

Table (2) demonstrate the risk factors of anemia (diet, monitoring and medication) questions and the responding answer of patient show by

Questions MS. SD. RS. ASS
Reduce the intake of foods containing iron (such as red meat, celery, liver). 1.77 584 59 L
The eggs are boiled in different diets 1.95 626 65 L
Eating Milk or dairy products, such as cheese or cream, are treated regularly 2.07 728 69 M
Eat watermelon (watermelon) regularly. 1.70 522 56.6 L
Eat white meat, such as chicken or fish, regularly. 2.19 486 73 M
Eating fruits (orange or lemon) are treated regularly. 2.07 671 69 M
Eating Nuts (nuts, almonds or peanuts) and oats are taken regularly. 1.73 723 57.6 L
Eating Foods that contribute to increase the proportion of blood in the body such as schooner regularly. 1.58 638 52.6 L
Your daily diet includes rice. 2.19 631 73 M
Prefer to drink stimulant drinks (tea, coffee). 2.73 584 91 H
Eating Legumes (lentils, beans and others) are dealt with regularly. 1.48 559 49.3 L
Eat vegetables and fruits (peaches, figs, apricots, potatoes, beets, and broccoli) regularly. 1.77 548 59 L
Contain Your daily food contains green leafy vegetables such as lettuce, parsley, celery, etc. 2.11 549 70.3 M
Prefer to eat bread made from whole grains such as barley or oatmeal. 1.29 574 43 L
Table (2) demonstrate the risk factors of anemia (diet, monitoring and medication) questions and the responding answer of patient show by

(B) Question's Related To Monitor
1) Hemoglobin analysis was performed to determine the blood ratio before and after each hemodialysis. 2.68 533 89.33 H
2) You record and compare the results to the analyzes after each blood enforcement to monitor your health improvement. 2.60 696 86.66 H
3) Keep the joint in the arm or neck (sock) clean and sterile. 2.74 579 91.33 H
4) 4. Make sure there is no bleeding when the blood enforcement process is completed. 2.81 506 93.66 H
5) Avoid sudden movements such as standing during the bloody enforcement process. 2.77 58 4 92.33 H
6) Monitor the location of the joint to detect any bleeding, bleeding, swell, and redness on a regular basis 2.85 5 0 2 9 5 H
Table (2) demonstrate the risk factors of anemia (diet, monitoring and medication) questions and the responding answer of patient show by

(C) Question's Related To Medication
1) Take medicines prescribed by the doctor with strict adherence to the prescription. 2.82 437 94 H
2) You take vitamin pills C regularly. 1.38 648 46 L
3) The drugs contain the vitamin group B (B12,B6 B2). 1.40 682 46.66 L
4) Take medicines that contain folic acid (such as beans and beans). 2.05 968 68.33 M
5) Calcium tablets or calcium-containing antacids. 2.93 293 97.66 H

M.S =mean of score S.D = Stander deviation R.S= Relative suf fic iency Ass.= Assessment (L.= Low , M. Medium H.= High)

Table (3): Association among predicted characteristics variables and assessment of their effect according to relative sufficiency.

Predicted variables P- Value Significance
Age Grope 0.74 NS
Gander 0.894 NS
Educational Level 0.648 NS
Marital Status 0.797 NS
Duration of renal failure 0.496 NS
Number of hemodialysis each week 0.006 NS

NS. Non-Significant Descript ive Statistics (Non-Significant , P-Value) Among Predicted Characteristics Variables. Significant = less than 0.05 Non-Significant = more than 0.06

This table show the association between the demographic characteristic with the anemia prevalence and risk factor of it among hemodialysis patient are no significance effect for the (age, gander, Marital Status, Educational Level, etc.) .

And finally the result of study shows that the prevalence of anemia in hemodialysis patient was that all hemodialysis patient is suffer from anemia and their number 100.

This results are agreement with the results of B. Dilorio, etal (2007) who stated that the prevalence of anemia (hemoglobin 11 g/100 mL and EPO treatment at any Hb level) was 88.7%, and the prevalence of uncontrolled anemia was 39.4% (10).

 <bold id="_bold-333">Conclusions</bold>

According to the study results, the come with conclusion that all hemodialysis patients have anemia and the patients were mostly elderly women who were 61 years of age and older. and (33%) of the patients have had the renal failure condition for five years or more. Also three times a week is the preferred treatment schedule for more than half of individuals receiving hemodialysis (56%). Where 97% of patients' fathers or mothers aren’t have anemia, and 98% of patients' fathers or mothers are thalassemia-free. Also More than half of patients lost more than 3 kg during each session.

Recommendation :

According to study conclusion Offering patient education programs regarding self-care and how it affects illness complications. Also providing patients who are anemic with posters and a folder about a healthy diet for treating anemia. offer instructional programs on electrolyte monitoring, laboratory tests for anemia, and medication risk factors. Prepare and present a brochure with diet instructions for hemodialysis patients. Conducting additional research on the obstacles (food, monitoring, and medicines) that hemodialysis patients must overcome.