EVALUATION OF FACTORS AFFECTING THE DEVELOPMENT OF HOSPITAL-ACQUIRED ANEMIA IN CHRONIC KIDNEY DISEASE

Year 2023, Volume: 32 Issue: 3, 394 - 398, 04.12.2023

Burcu Caner , Ömer Toprak

https://doi.org/10.34108/eujhs.1200354

Abstract

Chronic kidney disease (CKD) is a functional or structural disorder in the kidneys and/or a decrease in the glomerular filtration rate (GFR) lasting longer than 3 months. The development of anemia in patients following hospitalization that has no identifiable etiological reason is known as hospital-acquired anemia (HAA). It is thought to be iatro-genic. In our study, we aimed to determine the prevalence of HAA and the factors affecting its development in CKD patients. Patients aged 18 years and older who were hospitalized for CKD between March and September 2014 were included in the study. Patients with hypervolemia, hemorrhage, hemolysis, sepsis, hematological malignancies, anticoagulant use, or who were planned for fluid replacement or renal replacement therapy were excluded. HAA was defined as a hemoglobin level fall of at least 0.5 g/dl following hospitalization. In our study, the frequency of HAA in CKD patients was found to be 70%. The development of HAA was significantly associated with the CKD stage and the presence of hypothyroidism (CKD p = 0.021, hypothyroidism p = 0.002). Phlebotomy volume per day (p = 0.203) and length of hospital stay (p = 0.180) were not related to HAA development. We believe that identifying HAA risk factors and taking preventative measures will benefit patients' health.

Keywords

Anemia, Renal insufficiency, Chronic, Phlebotomy

KRONİK BÖBREK HASTALIĞI VARLIĞINDA HASTANEDE EDİNİLMİŞ ANEMİ GELİŞİMİNE ETKİ EDEN FAKTÖRLERİN DEĞERLENDİRİLMESİ

Abstract

Kronik böbrek hastalığı (KBH) 3 aydan uzun süren, böbrekte işlevsel ya da yapısal bozukluk ve/veya glomerüler filtrasyon hızında azalma olmasıdır. Hastanede edinilmiş anemi (HEA), hastaneye yatış sonrası hastalarda etyolojik bir neden olmaksızın anemi gelişmesidir. İyatrojenik geliştiği düşünülmektedir. Çalışmamızda KBH tanısıyla hasta-neye yatırılan hastalarda HEA prevalansını ve etki eden faktörleri saptamayı amaçladık. Mart- Eylül 2014 arasında, 18 yaş ve üzerine, KBH tanılı, nefroloji servisine yatışı yapılan hastalar çalışmaya alındı. Hipervolemi, kanama, hemoliz, sepsis, hematolojik malignite varlığı, antikoagülan kullanımı olan hastalar, sıvı replasmanı planlanan ve renal replasman tedavisi alan hastalar çalışmaya dahil edilmedi. Hastaneye yatış sonrasında hemoglobin düzeyinde 0,5 g/dl ve üzerinde düşme olması HEA olarak tanımlandı. Çalışmamızda KBH hastalarında HEA sıklığı %70 saptanmıştır. HEA gelişimi, KBH evresi ve hipotiroidi varlığı ile istatiksel anlamlı olarak ilişkili saptanmıştır (KBH p=0.021, hipotiroidi p=0.002). Günlük flebotomi miktarınin (p=0,203) ve hastanede yatış süresinin (p=0,180) HEA gelişimi ile ilişkisi saptanmamıştır. HEA’nın tanınması ve gelişimi açısından risk faktörlerinin saptanarak, önlenmesinin hastaların sağlık durumuna olumlu etki edeceği düşüncesindeyiz.

Keywords

Anemi, Böbrek yetmezliği, Kronik, Flebotomi

References

• Levin A, Stevens PE, Bilous R, et al. Kidney disease: Improving global outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evalua-tion and management of chronic kidney disease. GBD Chronic Kidney Disease Col-laboration. In: Kidney International Supplements 2013; 3(1): 1-150
• GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2020;395(10225):709-733.
• Süleymanlar G, Utaş C, Arinsoy T, et al. A population-based survey of Chronic RE-nal Disease In Turkey--the CREDIT study. Nephrol Dial Transplant 2011;26(6):1862-1871.
• Makam AN, Nguyen OK, Clark C, Halm EA. Incidence, Predictors, and Outcomes of Hospital-Acquired Anemia. J Hosp Med. 2017;12(5):317-322.
• Czempik PF, Wilczek D, Herzyk J, Krzych ŁJ. Hospital-Acquired Anemia in Pati-ents Hospitalized in the Intensive Care Unit: A Retrospective Cohort Study. J Clin Med. 2022;11(14):3939.
• Koch CG, Li L, Sun Z, et al. From Bad to Worse: Anemia on Admission and Hospi-tal-Acquired Anemia. J Patient Saf. 2017;13(4):211-216.
• Shander A, Corwin HL. A Narrative Review on Hospital-Acquired Anemia: Kee-ping Blood where It Belongs. Transfus Med Rev. 2020;34(3):195-199.
• Portolés J, Martín L, Broseta JJ, Cases A. Anemia in Chronic Kidney Disease: From Pathophysiology and Current Treatments, to Future Agents. Front Med (Lausanne). 2021;8:642296.
• Felding P, Tryding N, Hyltoft Petersen P, Hørder M. Effects of posture on concent-rations of blood constituents in healthy adults: practical application of blood speci-men collection procedures recommended by the Scandinavian Committee on Refe-rence Values. Scand J Clin Lab Invest. 1980;40(7):615-621.
• Lima-Oliveira G, Guidi GC, Salvagno GL, Danese E, Montagnana M, Lippi G. Pati-ent posture for blood collection by venipuncture: recall for standardization after 28 years. Rev Bras Hematol Hemoter. 2017;39(2):127-132.
• Villani R, Romano AD, Rinaldi R, et al. Prevalence and risk factors for hospital-acquired anemia in internal medicine patients: learning from the "less is more" pers-pective. Intern Emerg Med. 2023;18(1):177-183.
• Jackson Chornenki NL, James TE, Barty R, et al. Blood loss from laboratory testing, anemia, and red blood cell transfusion in the intensive care unit: a retrospective study. Transfusion. 2020;60(2):256-261.
• Salisbury AC, Alexander KP, Reid KJ. Incidence, correlates, and outcomes of acu-te, hospital-acquired anemia in patients with acute myocardial infarction. Circulation 2010; 3: 337–46.
• Salisbury AC, Amin AP, Reid KJ, et al. Hospital-acquired anemia and in-hospital mortality in patients with acute myocardial infarction. Am Heart J. 2011;162(2):300-309.e3.
• Thavendiranathan P, Bagai A, Ebidia A, Detsky AS, Choudhry NK. Do blood tests cause anemia in hospitalized patients? The effect of diagnostic phlebotomy on he-moglobin and hematocrit levels. J Gen Intern Med. 2005;20(6):520-524.
• Hansen MF, Munk JK, Lind B, Bathum L, Buhl H, Jørgensen HL. Hospital-acquired anemia among patients in a university hospital and the affiliated general practices in the capital region of Denmark, 2019. Scand J Clin Lab Invest. 2022;82(4):277-282.
• Weisbach V, Corbière C, Strasser E, Zingsem J, Zimmermann R, Eckstein R. The variability of compensatory erythropoiesis in repeated autologous blood donation. Transfusion. 2001;41(2):179-183.
• Bressman E, Jhang J, McClaskey J, Ginzburg YZ. Tackling the unknowns in unders-tanding and management of hospital acquired anemia. Blood Rev. 2021;49:100830.