Prevalence of anemia in dialysis patients in Northwestern of Libya
DOI:
https://doi.org/10.54361/LJMR.16.2B.11Keywords:
Chronic kidney disease, erythropoietin, anemia, hemoglobin, iron loose, Sabratha.Abstract
Background. Chronic kidney disease (CKD) is renal dysfunction lead to fail in body's ability to maintain metabolic, fluid electrolyte, and balance. It is mostly results in uremia or azotemia and can be classified into stages 1 to 5 based on the deterioration of glomerular filtration rate (GFR. These complications lead to the deficiency of erythropoietin (EPO) possible iron loss in patients on hemodialysis are considered the main factors in contributing anemia in CKD patients.
Aimes: This study aims to evaluate the prevalence of anemia in CKD patients aged 18 years and above. Methods: A cross sectional study was performed on a 90 participants from patient with confirmed stage 5 of CKD who were on follow up at the dialysis unit of Sabratha and Surman Hospitals.
Results: The prevalence of anemia in dialysis patients’ was found to be extremely high as 97.8% (88/90), and most effected patient was belonged to age group 45-64 (54.4%). Interestingly, the elders (65-84) years old patients was the least effected group (17,8%) which also showed only one case of severe anemia (hemoglobin < 7 g/dl)
Conclusion: This study is strongly confirms the suggestions of anemia contributions in CKD patient spatially in late stages.
Recommendations: According to the high incidence of anemia among CKD patients, its highly recommended that routine hemoglobin checkup most be followed, and diet supplements might be required to replace the iron loose.
Downloads
References
1. AGARWAL, R., 2007. Nonhematological benefits of iron. American Journal of Nephrology, 27(6), pp. 565-571.
2. AKINSOLA, A., DUROSINMI, M.O. and AKINOLA, N.O., 2000. The haematological profile of Nigerians with chronic renal failure. African Journal of Medicine and Medical Sciences, 29(1), pp. 13-16.
3. ALEMU, B., TECHANE, T., DINEGDE, N.G. and TSIGE, Y., 2021. Prevalence of Anemia and Its Associated Factors Among Chronic Kidney Disease Patients Attending Selected Public Hospitals of Addis Ababa, Ethiopia: Institutional-Based Cross-Sectional Study. International journal of nephrology and renovascular disease, 14, pp. 67-75.
4. AMOAKO, Y.A., LARYEA, D.O., BEDU-ADDO, G., ANDOH, H. and AWUKU, Y.A., 2014. Clinical and demographic characteristics of chronic kidney disease patients in a tertiary facility in Ghana. The Pan African medical journal, 18, pp. 274.
5. ANNEAR, N.M.P., BANERJEE, D., JOSEPH, J., HARRIES, T.H., RAHMAN, S. and EASTWOOD, J.B., 2008. Prevalence of chronic kidney disease stages 3-5 among acute medical admissions: another opportunity for screening. QJM : monthly journal of the Association of Physicians, 101(2), pp. 91-97.
6. ASHBY, D.R., GALE, D.P., BUSBRIDGE, M., MURPHY, K.G., DUNCAN, N.D., CAIRNS, T.D., TAUBE, D.H., BLOOM, S.R., TAM, F.W. and CHAPMAN, R.S., 2009. Plasma hepcidin levels are elevated but responsive to erythropoietin therapy in renal disease. Kidney international, 75(9), pp. 976-981.
7. BATCHELOR, E.K., KAPITSINOU, P., PERGOLA, P.E., KOVESDY, C.P. and JALAL, D.I., 2020. Iron Deficiency in Chronic Kidney Disease: Updates on Pathophysiology, Diagnosis, and Treatment. Journal of the American Society of Nephrology : JASN, 31(3), pp. 456-468.
8. BOCK, H.A., HIRT-MINKOWSKI, P., BRÜNISHOLZ, M., KEUSCH, G., REY, S., VON ALBERTINI, B. and SWISS EFIXNES TRIAL INVESTIGATORS, 2008. Darbepoetin alpha in lower-than-equimolar doses maintains haemoglobin levels in stable haemodialysis patients converting from epoetin alpha/beta. Nephrology Dialysis Transplantation, 23(1), pp. 301-308.
9. BROOKHART, M.A., SCHNEEWEISS, S., AVORN, J., BRADBURY, B.D., ROTHMAN, K.J., FISCHER, M., MEHTA, J. and WINKELMAYER, W.C., 2008. The effect of altitude on dosing and response to erythropoietin in ESRD. Journal of the American Society of Nephrology : JASN, 19(7), pp. 1389-1395.
10. CAPPELLINI, M.D., COMIN‐COLET, J., DE FRANCISCO, A., DIGNASS, A., DOEHNER, W., LAM, C.S., MACDOUGALL, I.C., ROGLER, G., CAMASCHELLA, C. and KADIR, R., 2017. Iron deficiency across chronic inflammatory conditions: International expert opinion on definition, diagnosis, and management. American Journal of Hematology, 92(10), pp. 1068-1078.
11. Cases-Amenós, A., Martínez-Castelao, A., Fort-Ros, J., et al. 2014. Prevalence of anaemia and its clinical management in patients with stages 3–5 chronic kidney disease not on dialysis in Catalonia: MICENAS I study. _Nefrologia . 34: 189–198
12. CASES, A., EGOCHEAGA, M.I., TRANCHE, S., PALLARÉS, V., OJEDA, R., GÓRRIZ, J.L. and PORTOLÉS, J.M., 2018. Anemia of chronic kidney disease: Protocol of study, management and referral to Nephrology. Nefrología (English Edition), 38(1), pp. 8-12.
13. CHANDRA, M., 1990. Pathogenesis of the anemia of chronic renal failure: The role of erythropoietin. Nefrologia, 10, pp. 12-22.
14. EISENGA, M.F., NOLTE, I.M., VAN DER MEER, P., BAKKER, S.J. and GAILLARD, C.A., 2018. Association of different iron deficiency cutoffs with adverse outcomes in chronic kidney disease. BMC nephrology, 19(1), pp. 1-8.
15. EVANS, M., BOWER, H., COCKBURN, E., JACOBSON, S.H., BARANY, P. and CARRERO, J., 2020. Contemporary management of anaemia, erythropoietin resistance and cardiovascular risk in patients with advanced chronic kidney disease: a nationwide analysis. Clinical kidney journal, 13(5), pp. 821-827.
16. FEHR, T., AMMANN, P., GARZONI, D., KORTE, W., FIERZ, W., RICKLI, H. and WÜTHRICH, R.P., 2004. Interpretation of erythropoietin levels in patients with various degrees of renal insufficiency and anemia. Kidney international, 66(3), pp. 1206-1211.
17. FISHBANE, S., BLOCK, G.A., LORAM, L., NEYLAN, J., PERGOLA, P.E., UHLIG, K. and CHERTOW, G.M., 2017. Effects of Ferric Citrate in Patients with Nondialysis-Dependent CKD and Iron Deficiency Anemia. Journal of the American Society of Nephrology : JASN, 28(6), pp. 1851-1858.
18. FRAZER, D.M. and ANDERSON, G.J., 2014. The regulation of iron transport. Biofactors, 40(2), pp. 206-214.
19. GOICOECHEA, M., DE VINUESA, S.G., GÓMEZ-CAMPDERÁ, F. and LUÑO, J., 2005. Predictive cardiovascular risk factors in patients with chronic kidney disease (CKD). Kidney international, 67, pp. S35-S38.
20. HSU, C., MCCULLOCH, C.E. and CURHAN, G.C., 2002. Iron status and hemoglobin level in chronic renal insufficiency. Journal of the American Society of Nephrology : JASN, 13(11), pp. 2783-2786.
21. INKER, L.A., GRAMS, M.E., LEVEY, A.S., CORESH, J., CIRILLO, M., COLLINS, J.F., GANSEVOORT, R.T., GUTIERREZ, O.M., HAMANO, T. and HEINE, G.H., 2019. Relationship of estimated GFR and albuminuria to concurrent laboratory abnormalities: an individual participant data meta-analysis in a global consortium. American journal of kidney diseases, 73(2), pp. 206-217.
22. JANKOWSKA, E.A., TKACZYSZYN, M., SUCHOCKI, T., DROZD, M., VON HAEHLING, S., DOEHNER, W., BANASIAK, W., FILIPPATOS, G., ANKER, S.D. and PONIKOWSKI, P., 2016. Effects of intravenous iron therapy in iron‐deficient patients with systolic heart failure: a meta‐analysis of randomized controlled trials. European journal of heart failure, 18(7), pp. 786-795.
23. JUMA, A., 2012. Prevalence of Anemia and its associated factors in patients with Chronic Kidney Disease at Muhimbili National Hospital Dar es Salaam, .
24. KANG, E., HAN, M., KIM, H., PARK, S.K., LEE, J., HYUN, Y.Y., KIM, Y.S., CHUNG, W., KIM, H.J., OH, Y.K., AHN, C. and OH, K.H., 2017. Baseline General Characteristics of the Korean Chronic Kidney Disease: Report from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). Journal of Korean medical science, 32(2), pp. 221-230.
25. KAUTZ, L., JUNG, G., VALORE, E.V., RIVELLA, S., NEMETH, E. and GANZ, T., 2014. Identification of erythroferrone as an erythroid regulator of iron metabolism. Nature genetics, 46(7), pp. 678-684.
26. KILONZO, K.G., CHRONIC RENAL FAILURE AND ASSOCIATED RISK FACTORS AMONG MEDICAL ADMISSIONS AT KCMC, MOSHI, .
27. LOCATELLI, F., BÁRÁNY, P., COVIC, A., DE FRANCISCO, A., DEL VECCHIO, L., GOLDSMITH, D., HÖRL, W., LONDON, G., VANHOLDER, R. and VAN BIESEN, W., 2013. Kidney Disease: Improving Global Outcomes guidelines on anaemia management in chronic kidney disease: a European Renal Best Practice position statement. Nephrology Dialysis Transplantation, 28(6), pp. 1346-1359.
28. MACDOUGALL, I.C., BOCK, A., CARRERA, F., ECKARDT, K., GAILLARD, C., VAN WYCK, D., ROUBERT, B., CUSHWAY, T., ROGER, S.D. and FIND-CKD STUDY INVESTIGATORS, 2014. The FIND-CKD study—a randomized controlled trial of intravenous iron versus oral iron in non-dialysis chronic kidney disease patients: background and rationale. Nephrology Dialysis Transplantation, 29(4), pp. 843-850.
29. MCGONIGLE, R.J., WALLIN, J.D., SHADDUCK, R.K. and FISHER, J.W., 1984. Erythropoietin deficiency and inhibition of erythropoiesis in renal insufficiency. Kidney international, 25(2), pp. 437-444.
30. MCMURRAY, J., PARFREY, P., ADAMSON, J.W., ALJAMA, P., BERNS, J.S., BOHLIUS, J., DRÜEKE, T.B., FINKELSTEIN, F.O., FISHBANE, S. and GANZ, T., 2012. Kidney disease: Improving global outcomes (KDIGO) anemia work group. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney International Supplements, , pp. 279-335.
31. MINUTOLO, R., LOCATELLI, F., GALLIENI, M., BONOFIGLIO, R., FUIANO, G., OLDRIZZI, L., CONTE, G., DE NICOLA, L., MANGIONE, F. and ESPOSITO, P., 2013. Anaemia management in non-dialysis chronic kidney disease (CKD) patients: a multicentre prospective study in renal clinics. Nephrology Dialysis Transplantation, 28(12), pp. 3035-3045.
32. MORENO, F., GOMEZ, J., JOFRE, R., VALDERRABANO, F., GONZALEZ, L. and GORRIZ, J., 1996. Nephrology dialysis transplantation quality of life in dialysis patients. A Spanish multicentre study.NDT, 11(Suppl 2), pp. 125-129.
33. NATIONAL COLLABORATING CENTRE FOR CHRONIC CONDITIONS (GREAT BRITAIN), 2006. Anaemia management in chronic kidney disease: national clinical guideline for management in adults and children, 2006, Royal College of Physicians.
34. NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE, 2015. Chronic kidney disease: managing anaemia. NICE guideline (NG8), .
35. NISSENSON, A.R., WADE, S., GOODNOUGH, T., KNIGHT, K. and DUBOIS, R.W., 2005. Economic burden of anemia in an insured population. Journal of managed care pharmacy, 11(7), pp. 565-574.
36. PALMER, S.C., SAGLIMBENE, V., MAVRIDIS, D., SALANTI, G., CRAIG, J.C., TONELLI, M., WIEBE, N. and STRIPPOLI, G.F., 2014. Erythropoiesis‐stimulating agents for anaemia in adults with chronic kidney disease: a network meta‐analysis. Cochrane Database of Systematic Reviews, (12),.
37. PEYSSONNAUX, C., ZINKERNAGEL, A.S., SCHUEPBACH, R.A., RANKIN, E., VAULONT, S., HAASE, V.H., NIZET, V. and JOHNSON, R.S., 2007. Regulation of iron homeostasis by the hypoxia-inducible transcription factors (HIFs). The Journal of clinical investigation, 117(7), pp. 1926-1932.
38. PORTOLÉS, J., GORRIZ, J.L., RUBIO, E., DE ÁLVARO, F., GARCÍA, F., ALVAREZ-CHIVAS, V., ARANDA, P. and MARTINEZ-CASTELAO, A., 2013. The development of anemia is associated to poor prognosis in NKF/KDOQI stage 3 chronic kidney disease. BMC nephrology, 14(1), pp. 1-9.
39. RAMBOD, M., KOVESDY, C.P. and KALANTAR-ZADEH, K., 2008. Combined high serum ferritin and low iron saturation in hemodialysis patients: the role of inflammation. Clinical journal of the American Society of Nephrology : CJASN, 3(6), pp. 1691-1701.
40. RAO, M., WONG, C., KANETSKY, P., GIRNDT, M., STENVINKEL, P., REILLY, M. and RAJ, D., 2007. Cytokine gene polymorphism and progression of renal and cardiovascular diseases. Kidney international, 72(5), pp. 549-556.
41. RATCLIFFE, L.E., THOMAS, W., GLEN, J., PADHI, S., PORDES, B.A., WONDERLING, D., CONNELL, R., STEPHENS, S., MIKHAIL, A.I. and FOGARTY, D.G., 2016. Diagnosis and management of iron deficiency in CKD: a summary of the NICE guideline recommendations and their rationale. American Journal of Kidney Diseases, 67(4), pp. 548-558.
42. ROTTEMBOURG, J., KADRI, A., LEONARD, E., DANSAERT, A. and LAFUMA, A., 2011. Do two intravenous iron sucrose preparations have the same efficacy? Nephrology Dialysis Transplantation, 26(10), pp. 3262-3267.
43. SARGENT, J.A. and ACCHIARDO, S.R., 2004. Iron requirements in hemodialysis. Blood purification, 22(1), pp. 112-123.
44. SMITH, R.E.J., 2010. The clinical and economic burden of anemia. The American Journal of Managed Care, 16 Suppl Issues, pp. S59-66.
45. STACK, A.G., ALGHALI, A., LI, X., FERGUSON, J.P., CASSERLY, L.F., CRONIN, C.J., REDDAN, D.N., HUSSEIN, W. and ELSAYED, M.E., 2018. Quality of care and practice patterns in anaemia management at specialist kidney clinics in Ireland: a national study. Clinical kidney journal, 11(1), pp. 99-107.
46. STAUFFER, M.E. and FAN, T., 2014. Prevalence of anemia in chronic kidney disease in the United States. PloS one, 9(1), pp. e84943.
47. SUEGA, K., BAKTA, M., DHARMAYUDHA, T.G., LUKMAN, J.S. and SUWITRA, K., 2005. Profile of anemia in chronic renal failure patients: comparison between predialyzed and dialyzed patients at the Division of Nephrology, Department of Internal Medicine, Sanglah Hospital, Denpasar, Bali, Indonesia. Acta medica Indonesiana, 37(4), pp. 190-194.
48. TALWAR, V.K., GUPTA, H.L. and SHASHINARAYAN, 2002. Clinicohaematological profile in chronic renal failure. The Journal of the Association of Physicians of India, 50, pp. 228-233.
49. TSUBAKIHARA, Y., GEJYO, F., NISHI, S., IINO, Y., WATANABE, Y., SUZUKI, M., SAITO, A., AKIBA, T., HIRAKATA, H. and AKIZAWA, T., 2012. High target hemoglobin with erythropoiesis‐stimulating agents has advantages in the renal function of non‐dialysis chronic kidney disease patients. Therapeutic Apheresis and Dialysis, 16(6), pp. 529-540.
50. TSUBAKIHARA, Y., GEJYO, F., NISHI, S., IINO, Y., WATANABE, Y., SUZUKI, M., SAITO, A., AKIBA, T., HIRAKATA, H. and AKIZAWA, T., 2012. High target hemoglobin with erythropoiesis‐stimulating agents has advantages in the renal function of non‐dialysis chronic kidney disease patients. Therapeutic Apheresis and Dialysis, 16(6), pp. 529-540.
51. ULASI, I.I. and IJOMA, C.K., 2010. The enormity of chronic kidney disease in Nigeria: the situation in a teaching hospital in South-East Nigeria. Journal of tropical medicine, 2010.
52. VAN SWELM, R.P., WETZELS, J.F. and SWINKELS, D., 2020. The multifaceted role of iron in renal health and disease. Nature Reviews Nephrology, 16(2), pp. 77-98.
53. WALTERS, D., KAKIETEK, J., DAYTON EBERWEIN, J. and SHEKAR, M., 2017. An investment framework for meeting the global nutrition target for anemia. World Bank Group, Washington, DC, USA, .
54. WENGER, R.H. and HOOGEWIJS, D., 2010. Regulated oxygen sensing by protein hydroxylation in renal erythropoietin-producing cells. American Journal of Physiology-Renal Physiology, 298(6), pp. F1287-F1296.
55. YI, S., MOON, S.J. and YI, J., 2019. Low-normal hemoglobin levels and anemia are associated with increased risk of end-stage renal disease in general populations: A prospective cohort study. PloS one, 14(4), pp. e0215920.
56. АНЕМІЇ, К., 2012. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney international, 2, pp. 279.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Mohamed Said, Mahmoud Agena (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Open Access Policy
Libyan journal of medical Research (LJMR).is an open journal, therefore there are no fees required for downloading any publication from the journal website by authors, readers, and institution.
The journal applies the license of CC BY (a Creative Commons Attribution 4.0 International license). This license allows authors to keep ownership f the copyright of their papers. But this license permits any user to download , print out, extract, reuse, archive, and distribute the article, so long as appropriate credit is given to the authors and the source of the work.
The license ensures that the article will be available as widely as possible and that the article can be included in any scientific archive.
Editorial Policy
The publication of an article in a peer reviewed journal is an essential model for Libyan journal of medical Research (LJMR). It is necessary to agree upon standards of expected ethical behavior for all parties involved in the act of publishing: the author, the journal editorial, the peer reviewer and the publisher.
Any manuscript or substantial parts of it, submitted to the journal must not be under consideration by any other journal. In general, the manuscript should not have already been published in any journal or other citable form, although it may have been deposited on a preprint server. Authors are required to ensure that no material submitted as part of a manuscript infringes existing copyrights, or the rights of a third party.
Authorship Policy
The manuscript authorship should be limited to those who have made a significant contribution and intellectual input to the research submitted to the journal, including design, performance, interpretation of the reported study, and writing the manuscript. All those who have made significant contributions should be listed as co-authors.
Others who have participated in certain substantive aspects of the manuscript but without intellectual input should only be recognized in the acknowledgements section of the manuscript. Also, one of the authors should be selected as the corresponding author to communicate with the journal and approve the final version of the manuscript for publication in the LJMR.
Peer-review Policy
- All the manuscripts submitted to LJMR will be subjected to the double-blinded peer-review process;
- The manuscript will be reviewed by two suitable experts in the respective subject area.
- Reports of all the reviewers will be considered while deciding on acceptance/revision or rejection of a manuscript.
- Editor-In-Chief will make the final decision, based on the reviewer’s comments.
- Editor-In-Chief can ask one or more advisory board members for their suggestions upon a manuscript, before making the final decision.
- Associate editor and review editors provide administrative support to maintain the integrity of the peer-review process.
- In case, authors challenge the editor’s negative decision with suitable arguments, the manuscript can be sent to one more reviewer and the final decision will be made based upon his recommendations.