Anemia in Dogs with Acute Kidney Injury

TL;DR

Anemia is common in dogs with acute kidney injury and is often non-regenerative, with severity increasing as kidney disease progresses.

Contribution

This study provides new insights into the frequency and characteristics of anemia in dogs with acute kidney injury.

Findings

Anemia was found in 72% of dogs with acute kidney injury.

Non-regenerative anemia was the most common type observed.

Anemia frequency increased with the progression of IRIS grade.

Abstract

Anemia is universally recognized as a common finding of both human and veterinary chronic kidney disease, but its role in acute kidney injury is still debated. The retrospective evaluation of medical records of AKI dogs showed that anemia was a common disorder, which was found in 72% of the study population. The majority of dogs with AKI showed mild to moderate, normochromic, normocytic, and non-regenerative anemia. The frequency of anemia was elevated for all the AKI etiologies, with increasing frequency with the progression of the IRIS grade. Anemia should be considered a common disorder in AKI dogs and should be promptly addressed and treated.

Anemia is a well-known complication in CKD dogs, but its frequency in AKI dogs has been poorly investigated. The aim of the present study was to retrospectively evaluate frequency, degree of severity, and regeneration rate of anemia in relation to IRIS grade, etiology, therapy, and outcome. Medical records of dogs (2017–2023) with historical, laboratory, and ultrasound findings consistent with AKI were retrospectively reviewed. According to etiology, AKI was classified as ischemic/inflammatory (IS), infectious (INF), nephrotoxic (NEP), obstructive (OBS), and unknown (UK). AKI dogs were also classified according to therapeutical management (medical vs. hemodialysis), survival to discharge (survivors vs. non-survivors). Anemia was defined as HCT < 37% and classified as mild (HCT 30–37%), moderate (HCT 20–29%), severe (13–19%), or very severe (<13%). Anemia was classified as microcytic (MCV < 61 fL), normocytic (61 and 73 fL), and macrocytic (>73 fL). Anemia was considered hypochromic (MCHC< 32 g/dL), normochromic (32 and 38 g/dL), and hyperchromic (>38 g/dL). Regeneration rate was considered absent (RET ≤ 60,000/μL), mild 61,000–150,000/μL), and moderate (>150,000/μL). A total of 120 AKI dogs were included in the study, and anemia was found in 86/120 dogs (72%). The severity of anemia was mild in 32/86 dogs (37%), moderate in 40/86 dogs (47%), severe in 11/86 dogs (13%), and very severe in 3/86 (3%). Anemia was normochromic in 71/86 dogs (83%), hyperchromic in 12/86 dogs (14%), and hypochromic in 3/86 dogs (3%). Normocytic anemia was present in 56/86 dogs (65%), microcytic anemia in 27/86 dogs (31%), and macrocytic anemia in 3/86 dogs (4%). Non-regenerative anemia was found in 76/86 dogs (88%). The frequency of anemia increased significantly (p < 0.0001) with the progression of IRIS grade, although no significant difference in the severity of anemia was found among the IRIS grades. The frequency of non-regenerative forms of anemia was significantly higher than regenerative forms (p < 0.0001) in all IRIS grades. In our population of AKI dogs, anemia was a very frequent finding, in agreement with current findings in human nephrology.