Review on iron deficiency anaemia in chronic kidney disease patients; prevalence and consequences related to other co morbidity conditions
- Menta Venkata Sarayu B. Pharmacy, IV Year, Ratnam Institute of Pharmacy, Pidathapolur (V & P), Muthukur (M), SPSR Nellore District-524 346, Andhra Pradesh.
-
M. Sowjanya
Assistant professor, Department of Pharmacy practice , Ratnam Institute of Pharmacy, Pidathapolur (V & P), Muthukur (M), SPSR Nellore District-524 346, Andhra Pradesh.
soujanyamurari111@gmail.com
- Y Prapurna Chandra Principal and Professor, Department of Pharmacology, Ratnam Institute of Pharmacy, Pidathapolur (V & P), Muthukur (M), SPSR Nellore District-524 346, Andhra Pradesh.
- Venugopalaiah Penabaka Professor, Department of Pharmaceutics, Ratnam Institute of Pharmacy, Pidathapolur (V & P), Muthukur (M), SPSR Nellore District-524 346, Andhra Pradesh.
- Afroz Patan Professor & HOD, Department of Pharmacy practice, Ratnam Institute of Pharmacy, Pidathapolur (V & P), Muthukur (M), SPSR Nellore District-524 346, Andhra Pradesh.
Abstract
Iron Deficiency Anemia (IDA) is a common and significant complication in patients with Chronic Kidney Disease (CKD), affecting up to 50–60% of individuals, especially in advanced stages. The presence of comorbidities such as Cardiac heart failure (CHF), Rheumotological diseases, Chronic obstructive pulmonary disease(COPD), Diabetes mellitus(DM) and cardiovascular disease(CVD) further compounds the burden of Iron deficiency anemia, both in terms of prevalence and clinical outcomes. Patients with CKD and diabetes are more prone to anemia due to heightened systemic inflammation, oxidative stress, and autonomic neuropathy affecting gastrointestinal iron absorption. Similarly, cardiovascular disease is both a consequence and a driver of anemia, as Iron deficiency anemia contributes to increased cardiac workload, left ventricular hypertrophy, and heart failure, while chronic heart conditions can suppress erythropoietin. The coexistence of Iron deficiency anemia with these comorbidities is associated with worsened quality of life, increased hospitalizations, accelerated CKD progression, and higher mortality rates.
Keywords:
Iron Deficiency Anemia, Chronic Kidney Disease, Cardiac heart failure, Diabetes Mellitus, Cardiovascular Disease, Co morbidities, Prevalence, Outcomes
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27. ashalatha da, raj kp, vani vv, lakshmikanth sl. study on safety of insulin add on therapy and oral hypoglycemic agents (ohgas) in type-ii diabetes patients. world journal of current medical and pharmaceutical research. 2020 sep 9:301-6.
28. Badura K, Janc J, Wąsik J, Gnitecki S, Skwira S, Młynarska E, Rysz J, Franczyk B. Anemia of Chronic Kidney Disease-A Narrative Review of Its Pathophysiology, Diagnosis, and Management. Biomedicines. 2024 May 27;12(6)
29. Schröder O, Schrott M, Blumenstein I, Jahnel J, Dignass A, Stein J. A study for the evaluation of safety and tolerability of intravenous high-dose iron sucrose in patients with iron deficiency anemia due to gastrointestinal bleeding. Zeitschrift Für Gastroenterologie. 2004;42(8):663–667. Available from: https://doi.org/10.1055/s-2004-813106
30. Agarwal N, Prchal JT. Anemia of chronic disease (anemia of inflammation) Acta Haematologica. 2009;122(2-3):103–108. Available from: https://doi.org/10.1159/000243794
31. Sugahara M, Tanaka T, Nangaku M. Hypoxia-Inducible Factor and Oxygen Biology in the Kidney. Kidney360. 2020;1(9):10211031.Availablefrom: https://doi.org/10.34067%2FKID.0001302020
32. USRDS. United States Renal Data Systems Annual Data Report. Am J Kid Dis2007;49( Suppl. 1): S10– S294.
33. Herzog CA, Mangrum JM, Passman R. Sudden cardiac death and dialysis patients. Semin Dial 2008; 21: 300– 307
2. Elghetany MT, Banki K. Erythrocytic disorders. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Philadelphia, PA: Elsevier; 2022:chap 33.
3. Camaschella C. Disorders of iron homeostasis: iron deficiency and overload. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 37.
4. Chapter 1: Definition and classification of CKD. Kidney Int Suppl (2011). 2013 Jan;3(1):19-62.
5. Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, Kurella Tamura M, Feldman HI. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am Kidney J Dis. 2014 May;63(5):713-35.
6. Stauffer ME, Fan T. Prevalence of anemia in chronic kidney disease in the United States. PLoS One. 2014;9(1):e84943. doi:10.1371/journal.pone.0084943. Published January 2, 2014. Accessed July 6, 2020. www.ncbi.nlm.nih.gov/pmc/articles/PMC3879360 NIH external link
7. Babitt JL, Lin HY. Mechanisms of anemia in CKD. Journal of the American Society of Nephrology. 2012;23(10):1631–1634. doi:10.1681/ASN.2011111078
8. Fishbane S, Spinowitz B. Update on anemia in ESRD and earlier stages of CKD: Core curriculum 2018. American Journal of Kidney Diseases. 2018;71(3):423–435. doi:10.1053/j.ajkd.2017.09.026
9. Lerma EV. Anemia of chronic disease and renal failure. Medscape. Updated November 27, 2018. Accessed July 6, 2020. https://emedicine.medscape.com/article/1389854-overview External link
10. Chronic Kidney Disease in the United States, 2019. Centers for Disease Control and Prevention. US Department of Health and Human Services, Centers for Disease Control and Prevention; 2019. Accessed July 6, 2020.
11. Badura K, Janc J, Wąsik J, Gnitecki S, Skwira S, Młynarska E, Rysz J, Franczyk B. Anemia of Chronic Kidney Disease-A Narrative Review of Its Pathophysiology, Diagnosis, and Management. Biomedicines. 2024 May 27;12(6)
12. Moreno F, Gomez JML, Jofre R, Valderrabano F, Gonzalez L, Gorriz JL, et al. Nephrology dialysis transplantation quality of life in dialysis patients. A Spanish multicentre study. NDT. (1996) 11(Suppl 2):125–9. doi: 10.1093/ndt/11.supp2.125
13. Lefebvre P, Vekeman F, Sarokhan B, Enny C, Provenzano RCP. Relationship between hemoglobin level and quality of life in anemic patients with chronic kidney disease receiving epoetin alfa. Curr Med Res Opin. (2006) 22:1929–37. doi: 10.1185/030079906X132541
14. Vyshnavi P, Venkatesh P. Review on diabetes mellitus. Journal of Innovations in Applied Pharmaceutical Science (JIAPS). 2022 Jan 2.
15. Astor BC, Coresh J, Heiss G, Pettitt D. Kidney function and anemia as risk factors for coronary heart disease and mortality: the atherosclerosis risk in communities (ARIC) study. Am Hear J. (2006) 151:492–500. doi: 10.1016/j.ahj.2005.03.055
16. Kovesdy CP, Trivedi BK, Kalantar-Zadeh K, Anderson JE. Association of anemia with outcomes in men with moderate and severe chronic kidney disease. Kidney Int. (2006) 69:560–4. doi: 10.1038/sj.ki.5000105
17. Nissenson AR, Wade S, Goodnough T, Knight K, Dubois RW. Economicburden of anemia in an insured population. J Manag Care Pharm. (2005) 11:565 74.doi; 10.18553/jmcp.2005.11. 7. 565
18. Stauffer ME, Fan T. Prevalence of anemia in chronic kidney disease in the United States. PLoS ONE. (2014) 9:2–5. doi: 10.1371/journal.pone.0084943
19. srikanth a, maithri a, karthik j, tharun k, mahesh k, praveen t. review on co-morbidities in diabetes mellitus. international journal of current innovations in advanced research. 2023 mar 24:10-6.
20. R. Gunaseelan, I. W. Surudarma, D. M. Wihandani, and I. W. G. Sutadarma, “Prevalence of anemia on chronic kidney disease and itsinfluenced factors in Sanglah General Hospital 2015–2017, Bali,” Intisari Sains Medis, vol. 11, no. 1, pp. 248–252, 2020
21. Stauffer ME, Fan T. Prevalence of anemia in chronic kidney disease in the United States. PLoS One. 2014;9:e849431–4.
22. Muniyandi D, Shanmugam N, Ramanathan K, et al. Prevalence of iron deficiency anemia among chronic kidney disease patients in Kaveri Delta. Br J Med Med Res. 2016;15:1–6.
23. Li Y, Shi H, Wang W-M, et al. Prevalence, awareness, and treatment of anemia in Chinese patients with no dialysis chronic kidney disease. First multicenter, cross- sectional study. Medicine (Baltim). 2016;95:e38721–8.
24. Nalado AM, Mahlangu JN, Waziri B, et al. Ethnic prevalence of anemia and predictors of anemia among chronic kidney disease patients at a tertiary hospital in Johannesburg, South Africa. Int J Nephrol Renovasc Dis. 2019;12:19–32.
25. Kaze FF, Kengne A, Mambap AT, et al.Anemia in patients on chronic hemodialysis in Cameroon: prevalence, characteristics and management in low resources setting. Afr Health Sci. 2015;15:253–60.
26. Gilbertson DT, Li S, Peng Y, et al. Anemia prevalence and treatment rates in stage 3-5 non-dialysis-dependent chronic kidney disease patients. Chronic Dis Res Gr. 2016;1.
27. ashalatha da, raj kp, vani vv, lakshmikanth sl. study on safety of insulin add on therapy and oral hypoglycemic agents (ohgas) in type-ii diabetes patients. world journal of current medical and pharmaceutical research. 2020 sep 9:301-6.
28. Badura K, Janc J, Wąsik J, Gnitecki S, Skwira S, Młynarska E, Rysz J, Franczyk B. Anemia of Chronic Kidney Disease-A Narrative Review of Its Pathophysiology, Diagnosis, and Management. Biomedicines. 2024 May 27;12(6)
29. Schröder O, Schrott M, Blumenstein I, Jahnel J, Dignass A, Stein J. A study for the evaluation of safety and tolerability of intravenous high-dose iron sucrose in patients with iron deficiency anemia due to gastrointestinal bleeding. Zeitschrift Für Gastroenterologie. 2004;42(8):663–667. Available from: https://doi.org/10.1055/s-2004-813106
30. Agarwal N, Prchal JT. Anemia of chronic disease (anemia of inflammation) Acta Haematologica. 2009;122(2-3):103–108. Available from: https://doi.org/10.1159/000243794
31. Sugahara M, Tanaka T, Nangaku M. Hypoxia-Inducible Factor and Oxygen Biology in the Kidney. Kidney360. 2020;1(9):10211031.Availablefrom: https://doi.org/10.34067%2FKID.0001302020
32. USRDS. United States Renal Data Systems Annual Data Report. Am J Kid Dis2007;49( Suppl. 1): S10– S294.
33. Herzog CA, Mangrum JM, Passman R. Sudden cardiac death and dialysis patients. Semin Dial 2008; 21: 300– 307
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Menta, V. S., M, S., Y, P. C., Penabaka, V., & Patan, A. (2025). Review on iron deficiency anaemia in chronic kidney disease patients; prevalence and consequences related to other co morbidity conditions. Asian Journal of Hospital Pharmacy, 5(3), 27-33. https://doi.org/10.38022/ajhp.v5i3.112
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