Iron status in chronic kidney disease patients

Rumi Deori, Bedanta Bhuyan


Background: In developing countries, chronic kidney disease (CKD) associated with anaemia is one of the major public health problems. With the progression of the disease, development of haematological abnormalities including iron deficiency increases. Renal anaemia may further increase the morbidity in these patients. Therefore, earlier detection and correction of anaemia may be helpful in preventing the progression of the diseases and its other adverse outcomes.

Methods: The present study was designed to observe the iron status in diagnosed CKD patients (pre-dialysis). For this purpose, 50 adult diagnosed CKD subjects who were not on any haematinics were randomly selected from the Departments of Medicine and Nephrology in a tertiary care hospital in Assam, India. 50 age and sex matched healthy controls were also included.  Haemoglobin concentration, serum iron, TIBC, transferrin saturation (TSAT) and serum creatinine were estimated by standard laboratory techniques. Statistical data were analyzed by using SPSS 21.

Results: All the CKD subjects were anaemic with haemoglobin concentration below 11g/dl and 48% of them showed moderate degree of anaemia. Their serum creatinine level were >3mg/dl.  The primary aetiologies of CKD were diabetes (44%) and hypertension (36%). Serum creatinine and total iron binding capacity (TIBC) were significantly (P <0.05) raised in CKD patients while serum iron was significantly lower in CKD subjects than in the control group. 26% of them had iron deficiency anaemia (TSAT <20%).  

Conclusions: Anaemia is one of the commonest and earliest manifestations in CKD patients. With serum creatinine >3 mg/dl, iron deficiency anaemia may be present. 


Anaemia, Chronic kidney disease, Iron deficiency, Transferrin saturation

Full Text:



Dewardener HE. An outline of normal and abnormal function. In: The kidney. 4th edition Churchill Livingstone. New York;1986:181-235.

Andrew SL, Josef C, Ethan B, Annamaria T, Adeera E, Michael WS, et al. National kidney foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Annals Internal Medicine. 2003;139(2):137-47.

Jha V, Garcia GG, Iseki K, Zuo L, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382(9888):260-72.

Barsoum RS. Chronic kidney disease in the developing world. N Engl J Med. 2006;354:997-9.

Haroun MK, Jaar BG, Hoffman SC, Comstock GW, Klag MJ, Coresh J. Risk factors for chronic kidney disease: a prospective study of 23, 534 men and women in Washington County, Maryland. J Am Soc Nephrol. 2003;14:2934-41.

Charmaine EL, Matthew JO, Deanna MR, Janet EH. The growing volume of diabetes-related dialysis: a population based study. Nephrology Dialysis Transplantation. 2004;19:3098-103.

Rajapurkar MM, John GT, Kirpalani AL, Abraham G, Agarwal SK, Almeida AF. What do we know about chronic kidney disease in India: first report of the Indian CKD registry. BMC Nephrol. 2012;13:10.

Agarwal SK, Srivastava RK. Chronic kidney disease in India: challenges and solutions. Nephron Clin Pract. 2009;111:197-203.

Kher V. End-stage renal disease in developing countries. Kidney Int. 2002;62:350-62.

Mehdi U, Toto RD. Anaemia, diabetes, and chronic kidney disease. Diabetes Care. 2009; 32(7):1320-6.

Sweny P, Farrington K, Moorhead JF. Chronic renal failure. In: The kidney and its disorders. 9th edition,. New Delhi, India. Jaypee Medical;1989:359-369.

Brugnara C. Iron deficiency and erythropoiesis: new diagnostic approaches. Clin Chem. 2003;49:1573-8.

Wish JB. Assessing iron status: beyond serum ferritin and transferrin saturation. Clin J Am Soc Nephrol. 2006;1:4-8.

Madhusnata D, Halder A, Podder S, Sen R, Chakrabarty S, Sengupta B, et al. Anemia and hemoglobinopathies in tribal population of Easrtern and North-eastern India. Hematology. 2006;11(5):371-3.

Mohanty D, Gorakshakar AC, Roshan B, Colah R, Patel Z, Dilip C, et al. Interaction of iron deficiency anaemia and hemoglobinopathies among college students and pregnant women: a multi center evaluation in india. Haemoglobin. Int J Haemoglobin Res. 2014;38(4):252-7.

Barbara J. Bain, imelda bates basic haematological techniques. In: Dacie, Lewis. Practical Haematology. 9th ed. Churchill Livingstone. 2001:20.

Edmund J Lamb, Christopher P. Price. Kidney function test. In: Carl KB, Edward RA, David EB. Teitz Textbook of Clinical Chemistry & Molecular Diagnostics. 5th ed. 2012:680.

Trefer H, John HE, James CB, Basil TD. Haemoglobin, iron and bilirubin. In: Carl KB, Edward RA, David EB. Teitz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th ed. 2012:1013.

Elghetany MT, Banki K. Erythrocytic disorders. In: Henry’s Clinical Diagnosis and Management by Laboratory methods. 21st ed.New York: NY, Saunders;2007:506.

KDOQI. National kidney foundation: II. Clinical practice guidelines and clinical practice recommendations for anaemia in chronic kidney disease in adults. Am J Kidney Dis. 2006;47(5):16-85.

Camaschella C. Iron-deficiency anaemia. New England J Med. 2015;372:1832-43.

Fishbane S, Pollack S, Feldman HI, Joffe MM. Iron indices in chronic kidney disease in the National health and nutritional examination survey 1988-2004. Clin J Am Soc Nephrol. 2009;4:57-61.

Mezzano S, Droguett A, Burgos ME, Ardiles LG, Flores CA, Aros CA, et al. Renin-angiotensin system activation and interstitial inflammation in human diabetic nephropathy. Kidney Int. 2003;86:64-70.

Lukaszyk E, Lukaszyk M, Koc ZE, Tobolczyk J, Bodzenta LA, Malyszko J. Iron status and inflammation in early stages of chronic kidney disease. Kidney Blood Press Res. 2015;40(4):366-73.

Talwar VK, Gupta HL, Narayan S. Clinicohematological profile in chronic renal failure. J Assoc Physicians India. 2002;50:228-33.

Afshar R, Sanavi S, Salami J, Ahmadzadeh M. Hematological profile of chronic kidney disease (CKD) patients in Iran, in pre-dialysis stages and after initiation of hemodialysis. Saudi J Kidney Dis Transplantation. 2010;21:368-71.

Suega K, Bakta M, Dharmayudha TG, Lukman JS, Suwitra K. Profile of anemia in chronic renal failure patients. Acta Med Indones. 2005;37(4):190-4.

Nurko S. Anemia in chronic kidney disease: causes, diagnosis, treatment. Cleve Clin J Med. 2006;73(3):289-97.

Fishbane S, Pollack S, Feldman HI, Marshall MJ. Iron indices in chronic kidney disease in the national health and nutritional examination survey 1988-2004. Clinic J Am Soc Nephrol. 2009;4(1):57-61.

Mcclellan W, Aronoff SL, Bolton WK, Hood S, Lorber DL, Tang KL, et al. The prevalence of anemia in patients with chronic kidney disease. Curr Med Res Opin. 2004; 20(9):1501-10.

Gouva C, Nikolopoulos P, Ioannidis JP, Siamopoulos KC. Treating anaemia early in renal failure patients slows the decline of renal function: a randomized controlled trial. Kidney Int. 2004;66:753-60.

Mohanram A, Zhang Z, Shahinfar S, Keane WF, Brenner BM, Toto RD. Anemia and end-stage renal disease in patients with type 2 diabetes and nephropathy. Kidney Int. 2004;66:1131-38.

Thomas MC, Tsalamandris C, MacIsaac RJ, Jerums G. The epidemiology of Hb levels in patients with type 2 diabetes. Am J Kidney Dis. 2006;48:537-45.

Rossert J, Froissart M. Role of anemia in progression of chronic kidney disease. Semin Nephrol. 2006;26:283-9.

Mohanram A, Toto RD. Outcome studies in diabetic nephropathy. Semin Nephrol. 2003;23:255-71.

Norman JT, Fine LG. Intrarenal oxygenation in chronic renal failure. Clin Exp Pharmacol Physiol. 2006;33:989-96.

Iwano M, Neilson EG. Mechanisms of tubule interstitial fibrosis. Curr Opin Nephrol Hypertens. 2004;13:279-84.

Remuzzi G, Rossi E. Hematologic consequences of renal failure. In: Brenner BM, Ed. The Kidney. 5th ed. Philadelphia:WB Saunders Co;1995:2170-85.

Lee GR. The anaemias associates with renal disease, liver disease, endocrine disease, and pregnancy. In: Lee GR, Foester J, Lekuns J, Paraskevas F, Greer JPRodgers GM, eds. Wintrobe clinical hematology. 10th ed. Baltimore: Williams and Wilkins;1999:1497-1517.

Monograph. Signs and symptoms of uraemia. In: Block RM, Alfred HJ, Fan PY, Stoff JS, eds. Rose and Block’s clinical problems in nephrology. 1st ed. Boston: Little, Brown and Company;1996:497-523.