# Hematological Indices and Abnormalities in Chronic Kidney Disease and Their Associations With Disease Severity

## TL;DR

This study shows that blood-related issues like anemia and low platelet counts worsen as kidney disease progresses, highlighting the need for regular blood tests in patients.

## Contribution

The study provides new insights into how hematological abnormalities correlate with CKD severity across stages 3-5.

## Key findings

- Hemoglobin, hematocrit, and platelet counts decrease significantly with advancing CKD stages.
- Anemia prevalence increases from 38% in stage 3 to 92.3% in stage 5.
- Red cell distribution width increases with CKD progression, indicating greater red blood cell variability.

## Abstract

Background and objective: Chronic kidney disease (CKD) is frequently complicated by hematological abnormalities, including anemia, thrombocytopenia, and leukocyte disorders, which significantly impact morbidity and survival. This study aimed to evaluate hematological indices and abnormalities in patients with CKD and determine their associations with disease severity across stages 3-5.

Methods: This cross-sectional observational study was carried out in the Department of Nephrology, Lahore General Hospital, Pakistan, between August 2023 and February 2024, following Institutional Review Board approval. A total of 412 patients aged 18-70 years with CKD stages 3-5, defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria, were recruited using non-probability consecutive sampling after obtaining written informed consent. Patients with known hematological disorders, acute infections, malignancy, chronic hepatitis B or C, HIV, recent blood transfusion, use of erythropoiesis-stimulating agents, or pregnancy were excluded. Venous blood samples (10 mL) were collected under aseptic precautions and analyzed for hematological indices using the Sysmex KX-2 analyzer (Kobe, Japan). Biochemical parameters were measured on Cobas Integra 400 Plus (Roche Diagnostics, Germany).

Results: A total of 412 patients were evaluated, with a mean age of 44.26 ± 14.05 years; 181 (43.9%) were aged 18-45 years, and 231 (56.1%) were 46-70 years. Men comprised 266 (64.6%) and women 146 (35.4%). The mean disease duration was 4.93 ± 2.61 years, with 247 (60%) reporting <5 years. Diabetes mellitus (40%) and hypertension (31.3%) were the leading etiologies. CKD stages included 100 (24.3%) in stage 3, 169 (41%) in stage 4, and 143 (34.7%) in stage 5. Hemoglobin (Hb) declined from 12.65 ± 1.05 g/dL (stage 3) to 9.98 ± 1.97 g/dL (stage 5, p < 0.001). Hematocrit (Hct) decreased from 35.61 ± 4.33% to 29.20 ± 5.45%, red blood cell (RBC) count from 4.04 ± 0.74 × 10¹²/L to 3.38 ± 0.50 × 10¹²/L, and platelet (PLT) count from 272.15 ± 116.68 × 10⁹/L to 197.82 ± 130.32 × 10⁹/L. Red cell distribution width (RDW) increased from 13.58 ± 1.37% to 15.79 ± 1.50% (p < 0.001). Anemia was present in 38%, 68%, and 92.3% of stages 3, 4, and 5, respectively; thrombocytopenia (14%-34.3%), leukopenia (11%-25.2%), and leukocytosis (7%-22.4%) also increased significantly with disease severity.

Conclusion: Hematological indices deteriorate with advancing CKD, with anemia, thrombocytopenia, and leukocyte abnormalities showing strong associations with disease severity. Routine hematological monitoring is essential for early detection and management of these complications to mitigate disease-related morbidity and improve patient outcomes.