Ali Jabbar Abd Al-Husayn (1)
General Background: Anemia is a common and clinically significant complication among patients undergoing hemodialysis, contributing to increased morbidity and complex clinical management in chronic kidney disease. Specific Background: Patients with end-stage renal disease receiving maintenance hemodialysis frequently experience reduced hemoglobin levels related to impaired erythropoietin production, iron deficiency, and comorbid conditions. Knowledge Gap: Despite extensive international evidence, limited localized data are available regarding the prevalence and associated factors of anemia among hemodialysis patients in the studied setting. Aims: This study aimed to determine the prevalence of anemia and identify related demographic and clinical characteristics among patients undergoing hemodialysis. Results: The findings demonstrated a high proportion of anemia among hemodialysis patients, with variations observed according to age, gender, and selected clinical parameters. Laboratory indicators and treatment-related variables were associated with the occurrence and severity of reduced hemoglobin levels. Novelty: This study provides updated contextual evidence on anemia distribution within a defined hemodialysis population, contributing locally derived clinical data to the existing body of nephrology research. Implications: The results underscore the need for structured anemia monitoring, optimized management strategies, and continuous evaluation of hematological parameters in dialysis centers to support improved patient care and clinical decision-making.
Keywords: Anemia, Hemodialysis, Chronic Kidney Disease, Hemoglobin Level, Prevalence
Key Findings Highlights:
A substantial proportion of dialysis recipients presented with reduced hemoglobin values.
Demographic and clinical characteristics were linked to variations in blood parameters.
Routine hematological assessment remains essential in long-term renal replacement therapy.
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).
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.
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).
M.S =mean of score S.D = Stander deviation R.S= Relative suf fic iency Ass.= Assessment (L.= Low , M. Medium H.= High)
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).
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.
[1] A. J. Abd Al-Husayn, S. Alzeyadi, and H. A. Athbi, “Commitment of Lung Cancer Patients with Self-Care in Al-Imam Hussein Oncology Center at Karbala Governorate,” Indian Journal of Public Health Research and Development, vol. 9, no. 8, pp. 1075–1079, 2018.
[2] A. J. Al-Husayn et al., “Adherence to Self-Care Managements among Patients with End Stage Renal Disease at Habib Ibn-Mudaher in Kerbala City,” Indian Journal of Public Health Research and Development, vol. 9, no. 8, 2018.
[3] A. J. Al-Husayn et al., “Risk Factor of Herniated Disc among Adult Patient at Al-Hussein Medical City in Kerbala City,” Indian Journal of Public Health Research and Development, vol. 9, no. 8, 2018.
[4] A. J. Al-Husayn et al., “Determine of Diarrhea Risk Factor in Children under 6 Years at Kerbala Pediatric Teaching Hospital in Karbala Governorate,” Indian Journal of Public Health Research and Development, vol. 9, no. 8, 2018.
[5] A. W. Amjad et al., “Prevalence of Iron Deficiency Anemia in Hemodialysis Patients at NIKD,” Pakistan Journal of Medical and Health Sciences, vol. 15, no. 6, pp. 1192–1194, 2021.
[6] E. Barooti et al., “Prevalence of Iron Deficiency Anemia among Iranian Pregnant Women: A Systematic Review and Meta-Analysis,” Journal of Reproduction and Infertility, vol. 11, no. 1, pp. 17–24, 2010.
[7] J. Bashir, “Prevalence of Anemia in Hemodialysis Patients in Northwestern Libya,” 2023.
[8] V. Biniaz et al., “Prevalence of Functional Iron Deficiency Anemia in Patients Undergoing Hemodialysis,” Iranian Journal of Critical Care Nursing, vol. 7, no. 1, pp. 59–66, 2014.
[9] B. M. Chavers et al., “Prevalence of Anemia in Erythropoietin-Treated Pediatric as Compared to Adult Chronic Dialysis Patients,” Kidney International, vol. 65, no. 1, pp. 266–273, 2004.
[10] B. Di Iorio et al., “Prevalence and Correlates of Anemia and Uncontrolled Anemia in Chronic Hemodialysis Patients: The Campania Dialysis Registry,” The International Journal of Artificial Organs, vol. 30, no. 4, pp. 325–333, 2007.
[11] F. M. Mahmood and A. J. Abd Al-Husayn, “Attitudes, Knowledge, Practice, and Perceived Barriers of Nursing Staff towards Pressure Ulcer Prevention: A Correlational Cross-Sectional Study,” Journal for ReAttach Therapy and Developmental Diversities, vol. 6, no. 2s, pp. 283–291, 2023.
[12] A. T. Kausz et al., “Intractable Anemia among Hemodialysis Patients: A Sign of Suboptimal Management or a Marker of Disease?” American Journal of Kidney Diseases, vol. 45, no. 1, pp. 136–147, 2005.
[13] F. F. Kaze et al., “Anemia in Patients on Chronic Hemodialysis in Cameroon: Prevalence, Characteristics and Management in Low Resources Setting,” African Health Sciences, vol. 15, no. 1, pp. 253–260, 2015.
[14] C. M. Matos et al., “Prevalence and Management of Anemia in Hemodialysis Patients in a Brazilian Population of Predominantly African Descent,” The International Journal of Artificial Organs, vol. 36, no. 9, pp. 640–649, 2013.
[15] V. Pourfarziani et al., “Laboratory Variables and Treatment Adequacy in Hemodialysis Patients in Iran,” Saudi Journal of Kidney Diseases and Transplantation, vol. 19, no. 5, pp. 842–846, 2008.
[16] H. Tanner et al., “The Prevalence of Anemia in Chronic Heart Failure,” International Journal of Cardiology, vol. 86, no. 1, pp. 115–121, 2002.
[17] U. Verdalles et al., “Factors Related to the Absence of Anemia in Hemodialysis Patients,” Blood Purification, vol. 32, no. 1, pp. 69–74, 2011.
[18] F. M. Mahmood and A. J. Abd Al-Husayn, “Attitudes, Knowledge, Practice, and Perceived Barriers of Nursing Staff towards Pressure Ulcer Prevention: A Correlational Cross-Sectional Study,” Journal for ReAttach Therapy and Developmental Diversities, vol. 6, no. 2s, pp. 283–291, 2023.