EVALUATION OF IRON STATUS IN CHRONIC KIDNEY DISEASE PATIENTS

(A CASE STUDY OF ABUTH, ZARIA)

By

Author

Presented To

Department of Medicine

ABSTRACT
The burden of chronic kidney disease (CKD) is increasing rapidly worldwide and has become a major health issue. Iron deficiency anaemia is one contributory aspect of renal anaemia with increasing morbidity and mortality. Use of iron status markers is integral to assessment of deficiency, and to setting treatment goals in the successful management of anaemia and iron deficiency in CKD patients.Most data on anaemia of CKD in Nigeria revealed dearth of information on indices of iron status, which makes treatment interventions difficult in this setting. Therefore, this study was designed to address this gap. The objective of the study is to evaluate iron status among CKD patients in ABUTH,Zaria The study was a descriptive cross sectional study that involved 125 CKD patients and 125 age- and sex-matched controls. The patients were recruited consecutively from nephrology clinic while controls were sourced from hospital staff, patient’s relatives and general population of Zaria. Ferritin was analyzed using ELISA; colorimetric method was used to analyze iron, Total iron binding capacity andcreatinine.Quality Control material was obtained from pooled sera for ferritin and creatinine. Commercially prepared quality control (multi control) was used for iron and Total iron binding capacity. Transferrin saturation was calculated from iron and TIBC. SPSS version 17.0 was used for data analysis and p-value of <0.05 was taken as statistically significant.The three leading diseases causing CKD found in this study were hypertensive nephropathy, diabetic nephropathy and adult polycystic kidney disease (APKD). CKDpatients had significantly higher serum ferritin, TIBC, creatinine and iron when compared with controls (p<0.05), with mean±SD of210.85±138.28 ng/ml, 71.27±28.23μmol/l, 623.88±681.54μmol/l and 20.21±10.23μmol/l respectively. Serum ferritin significantly correlated positively with creatinine and negatively with eCrcl.When correlated with stages of CKD,serum ferritin was found to be significant between stages 1 and 4, 1 and 5, 2 and 5, stages 3 and 4,stages 3 and 5.Serum ironcorrelated positively with % TSAT while TIBC correlated negatively with %TSAT.The reference intervals of iron, TIBC, ferritin (males and females) and TSAT were found to be 6.8-40 μmol/l, 33-113μmol/l,18-304ng/ml,24-232ng/ml and 8.3-71% respectively in controls. In conclusion, this study revealed high incidence of APKD, in addition to the other well known causes of CKD, such as hypertension and diabetes.A significant percentage of CKD patients in this study had iron deficiency anaemia (IDA). Therefore, iron status should be incorporated in the armamentarium of tests for patients with CKD in order to properly correct IDA that is so highly prevalent in this population. These will help in attending to the challenges of iron deficiency anaemia management and poor response to erythropoietin