Anemia and End‐Stage Renal Disease in the Developing World

Abstract

In developing countries, multiple comorbidities such as malnutrition, parasitoses, and hemoglobinopathies contribute to the aggravation of anemia observed in patients with end-stage renal diseases. We analyze here the results of a retrospective evaluation of red-cells indices and iron parameters conducted at the end of December 2000 in 304 prevalent Tunisian patients (sex ratio, 1.05; mean age, 53.7 years) receiving chronic hemodialysis for a median duration of 49.6 months (range, 1.6 to 278). Anemia, observed in 87.8% of patients, was normochromic and normocytic in 73% of cases. Only 2% of patients had microcytic and hypochromic anemia. Iron deficiency was observed in 21.6% of anemic patients. The mean rate of hemoglobin was significantly higher in men and in patients with polycystic kidney disease as the cause of renal failure. There was a positive correlation between hemoglobin values and the quality of dialysis. Only 10.8% of patients were on recombinant human erythropoietin (rHuEPO) and 38% required regular transfusions. We conclude that anemia observed in our patients had, in most cases, the characteristics of renal anemia and could be attributed to a deficit of renal production of erythropoietin. However, for financial reasons, prescription of rHuEPO is rather restrictive and blood transfusion remains largely used. The nephrology community and dialysis providers should increase their efforts to improve the anemia care of dialyzed patients in developing countries.

Anemia in patients on chronic hemodialysis in Cameroon: prevalence, characteristics and management in low resources setting

“…The higher prevalence of anemia in our study was within the range of figures reported in similar groups of patients elsewhere 2,3,[13][14][15] . However, the predominantly microcytic and hypochromic patterns could be explained either by the inflammatory state associated with chronic infection or by the presence of context specific factors (not investigated) such as nutritional deficiencies, hemoglobinopathies and parasitic diseases 7,8 .…”

“…Our study also has some strengths in the sense that it provides a unique picture, which, in this setting can potentially contribute to raise more attention on anemia, a leading condition in people with CKD. It revealed the positive correlation between hematological profile and erythropoietin and IV iron therapy in a few patients receiving these therapies, even in non-optimal dose, due to financial constraints as reported in similar setting 14,15 . Our efforts in tracking a large number of our participants during follow-up provides some indicators of the burden of anemia in chronic hemodialysis patients and the outcome of anemia correction approaches in the context of limited access to ESA and intravenous iron therapies.…”

“…However, chronic hemodialyzed patients have chronic anemia due to the lack of erythropoietin production related to ESRD, achieving effective anemia correction in these patients in such settings by blood transfusion can be very challenging due to the scarcity of safe blood as already mentioned and the absence of a coordinated national blood transfusion service. In order to reduce the risk of blood transmitted diseases in our setting, improved access to ESA and IV iron should be the best way for correcting ESRD related anemia as recommended elsewhere 11,[13][14][15] . As of now, erythropoietin and IV iron accessibility is limited by the prohibitive cost which was about US$ 30 for 2000 IU of erythropoietin and US$ 25 for 100 mg of IV iron at the time this study was conducted.…”

“…An investigation of iron status in Tunisian chronic hemodialyzed patients revealed a 22% iron deficiency, with only 2% of the patients presenting with microcytic hypochromic anemia 14 . Our study also has some strengths in the sense that it provides a unique picture, which, in this setting can potentially contribute to raise more attention on anemia, a leading condition in people with CKD.…”

Meta-Analysis of Randomized Controlled Trials on Androgens versus Erythropoietin for Anaemia of Chronic Kidney Disease: Implications for Developing Countries

“…The main limitation of EPO use in developing countries is cost, making it unavailable to most patients [1, 2]. Androgens which are relatively cheap were used in the treatment of anaemia in dialysis patients before the advent of EPO [3].…”