Polycythemia in patients with chronic kidney disease in hemodialysis
Keywords:
chronic kidney disease, dialysis, polycythemia, altitude sickness.Abstract
Introduction: Patients with chronic kidney disease have anemia, which is less frequent in cities above 1000 meters above sea level.Objectives: To determine the clinical and laboratory characteristics of patients on hemodialysis at high altitude.
Methods: Descriptive, cross-sectional and correlational study in 70 patients from a dialysis center (3827 meters above sea level). Patients were divided according to hemoglobin level: Group 1 (< 10 g/dl), Group 2 (10 - 12 g/dl), Group 3 (12 - 18 g/dl) and Group 4 (≥ 18 g/dl). Epidemiological, clinical and laboratory variables were investigated. Absolute and relative frequencies, averages and standard deviation were calculated and descriptive analysis, chi-square test and ANOVA were applied.
Results : We observed a predominance of men (67 %) and a mean age of 60.7 ± 14.1 years. 45 % of the patients were hypertensive, with a significant difference (p< 0,05) between group 1 and 2. The mean hemoglobin was 12,99 ± 2,6 g/dl, and we found that 5.7 % of the evaluated had hemoglobin ≥ 18 g/dL. A direct relationship between hemoglobin and phosphorus was observed, although of low intensity (r< 0,300) and significant (p< 0,05); that is, there is a tendency to hyperphosphatemia in patients with polycythemia.
Conclusions: More than 60 % of patients with chronic kidney disease on hemodialysis who live at high altitude have high hemoglobin levels, above the recommended levels for this population. Furthermore, a relationship was established between polycythemia and older age, calcium, phosphorus, albumin and Kt/V levels and lower parathyroid hormone levels.
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References
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15. Alagoz S, Dincer M, Eren N, Bakir A, Pekpak M, Trabulus S, Seyahi N. Prevalence of anemia in predialysis chronic kidney disease: Is the study center a significant factor? PLoS One. 2020; 15(4): e0230980. DOI: 10.1371/journal.pone.0230980
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18. Babitt JL, Lin HY. Mechanisms of anemia in CKD. J Am Soc Nephrol. 2012; 23(10): 1631-4. DOI: 10.1681/ASN.2011111078
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20. Amaru R, Quispe T, Torres G, Mamani J, Aguilar M, Miguez H, et al. Caracterización clínica de la eritrocitosis patológica de altura. Rev Hematol Mex. 2016 [acceso: 16/01/2022]; 17(1): 8-20. Disponible en: https://www.medigraphic.com/pdfs/hematologia/re-2016/re161c.pdf
21. Hurtado A, Plata R, Cornejo A, Mas G, Carbajal L, Sharma S, Swenson ER, et al. Higher prevalence of unrecognized kidney disease at high altitude. J Nephrol. 2018; 31(2): 263-9. DOI: 10.1007/s40620-017-0456-0
22. Hurtado A, Fuquay R, Sirota J, Swenson ER, Schoene RB, Jefferson JA, et al. High altitude renal syndrome (HARS). J Am Soc Nephrol. 2011; 22(11): 1963-8. DOI: 10.1681/ASN.2010121316
23. Chen W, Liu Q, Wang H, Chen W, Johnson RJ, Dong X, et al. Prevalence and risk factors of chronic kidney disease: a population study in the Tibetan population. Nephrol Dial Transpl. 2011; 26(5): 1592-9. DOI: 10.1093/ndt/gfq608
24. Brookhart MA, Schneeweiss S, Avorn J, Bradbury BD, Rothman KJ, Fischer M, et al. The effect of altitude on dosing and response to erythropoietin in ESRD. J Am Soc Nephrol. 2008; 19: 1389-95. DOI: 10.1681/ASN.2007111181
25. Brookhart MA, Bradbury BD, Avorn J, Schneeweiss S, Winkelmayer WC. The effect of altitude change on anemia treatment response in hemodialysis patients. Am J Epidemiol. 2011; 173:768-77. DOI: 10.1093/aje/kwq423
26. Sibbel S, Maroni B, Brunelli S. The effect of altitude on erythropoiesis-stimulating agent dose, hemoglobin level, and mortality in hemodialysis patients. J Nephrol. 2017; 30:821-829. DOI: 10.1007/s40620-016-0350-1
27. Hurtado A, Palacios A, Figueroa J, Gónzalez-Polar J, Kaluguina A, Lopera M. Niveles de hemoglobina en pacientes en hemodiálisis a nivel del mar y a mayor altitud, y su relación con la calidad de vida. Rev Soc Peru Med Interna. 2013 [acceso: 18/01/2022]; 26(4): 171-7. Disponible en: http://revistamedicinainterna.net/index.php/spmi/article/view/211
28. Rosales-Mendoza K, Gonzales-Polar J, Sumen R, Vizcarra C, Hurtado-Aréstegui A. Saturación de oxígeno en pacientes durante hemodiálisis a diferentes altitudes. Acta Med Peru. 2021; 38(3):193-8. DOI: 10.35663/amp.2021.383.2146
29. Lee DH, Min JH, Bae SB, Gil HW, Yang JO, Lee EY, Hong SY. Idiopathic erythrocytosis in a patient on chronic hemodialysis. Kidney Res Clin Pract. 2015; 34(1):60-3. DOI: 10.1016/j.krcp.2014.09.004
30. Sheqwara J, Alkhatib Y, Dabak V, Kuriakose P. Idiopathic erythrocytosis in dialysis patients: a case report and literature review. Am J Nephrol. 2013; 37:333-8. DOI: 10.1159/000349927
2. Carrillo-Larco RM, Bernabé-Ortiz A. Mortalidad por enfermedad renal crónica en el Perú: tendencias nacionales 2003-2015. Rev. Peru. Med. Exp. Salud Publica. 2018; 35(3): 409-15. DOI: 10.17843/rpmesp.2018.353.3633
3. Herrera-Añazco P, Benites-Zapata V, Hernandez V, Mezones-Holguin E, Silveira-Chau M. Mortality in patients with chronic kidney disease undergoing hemodialysis in a public hospital of Peru. J. Bras. Nefrol. 2015; 37(2): 192-7. DOI: 10.5935/0101-2800.20150031
4. Mushi L, Marschall P, Fleßa S. The cost of dialysis in low- and middle-income countries: a systematic review. BMC Health Serv Res. 2015; 15: 506. DOI: 10.1186/s12913-015-1166-8
5. Loza Munarriz CA, Ramos Muñoz WC. Análisis de la situación de la enfermedad renal crónica en el Perú, 2015. Lima: Dirección General de Epidemiologia, Ministerio de Salud; 2016. [acceso:10/01/2022]. Disponible en: http://www.dge.gob.pe/portal/index.php?option=com_content&view=articl-e&id=598&Itemid=353
6. Sanyaolu A, Okorie C, Annan R, Turkey H, Akhtar N, Gray F, et al. Epidemiology and management of chronic renal failure: a global public health problem. Biostatistics Epidemiol Int J. 2018; 1(1): 11-16. DOI: 10.30881/beij.00005
7. Herrera-Añazco P, Pacheco-Mendoza J, Taype-Rondan A. La enfermedad renal crónica en el Perú. Una revisión narrativa de los artículos científicos publicados. Acta Med Peru. 2016 [acceso:15/01/2022]; 33(2):130-7. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1728-59172016000200007&lng=es
8. Carlini R, Campistrús M, Andrade L, Blanco C, Chifflet L, Cruz de Trujillo ZC, et al. Recomendaciones para el estudio y tratamiento de la anemia en pacientes con enfermedad renal crónica. Actualización mayo 2017. Nefrol latinoam. 2017; 14(3): 85-116. DOI: 10.1016/j.nefrol.2017.09.002
9. Amaru R, Vera O. Guía para el diagnóstico y tratamiento de las eritrocitosis patológicas en la altura. Rev Med La Paz. 2016 [acceso: 13/01/2022]; 22(2): 70 - 7. Disponible en: http://www.scielo.org.bo/pdf/rmcmlp/v22n2/v22n2_a12.pdf
10. Maina CK, Karimi PN, Mariita K, Nyamu DG, Mugendi GA, Opanga SA. Correlates and management of anemia of chronic kidney disease in a Kenyan Tertiary hospital. East Afri Med J. 2016 [acceso: 15/01/2022]; 93(10): 489-99. Disponible en: https://www.ajol.info/index.php/eamj/article/view/152410
11. Covic A, Jackson J, Hadfield A, Pike J, Siriopol D. Real-world impact of cardiovascular disease and anemia on quality of life and productivity in patients with non-dialysis-dependent chronic kidney disease. Adv Ther. 2017; 34: 1662-72. DOI: 10.1007/s12325-017-0566-z
12. Stauffer ME, Fan T. Prevalence of anemia in chronic kidney disease in the United States. PLoS One. 2014; 9(1): e84943. DOI: 10.1371/journal.pone.0084943
13. Kaze FF, Kengne AP, Mambap AT, Halle MP, Mbanya D, Ashuntantang G. Anemia in patients on chronic hemodialysis in Cameroon: prevalence, characteristics and management in low resources setting. Afr Health Sci. 2015; 15: 253-60. DOI: 10.4314/ahs.v15i1.33
14. Adera H, Hailu W, Adane A, Tadesse A. Prevalence Of Anemia And Its Associated Factors Among Chronic Kidney Disease Patients At University Of Gondar Hospital, Northwest Ethiopia: A Hospital-Based Cross Sectional Study. Int J Nephrol Renovasc Dis. 2019; 12: 219-228. DOI: 10.2147/IJNRD.S216010
15. Alagoz S, Dincer M, Eren N, Bakir A, Pekpak M, Trabulus S, Seyahi N. Prevalence of anemia in predialysis chronic kidney disease: Is the study center a significant factor? PLoS One. 2020; 15(4): e0230980. DOI: 10.1371/journal.pone.0230980
16. Akel M, Shamas K, Sakr F, Dabbous M, Safwan J, Cherfan M, et al. Evaluation of the management of anemia in hemodialysis patients in Lebanon. J Nephropharmacol. 2017; 6(2): 68-73. DOI: 10.15171/npj.2017.07
17. Fishbane S, Spinowitz B. Update on Anemia in ESRD and Earlier Stages of CKD: Core Curriculum 2018. Am J Kidney Dis. 2018; 71(3): 423-35. DOI: 10.1053/j.ajkd.2017.09.026
18. Babitt JL, Lin HY. Mechanisms of anemia in CKD. J Am Soc Nephrol. 2012; 23(10): 1631-4. DOI: 10.1681/ASN.2011111078
19. Wagner P. El factor HIF-1 inducido por la hipoxia y la sensibilidad al oxígeno: Rol del hierro intracelular. Acta Med Peru. 2011 [acceso:16/01/2022]; 28(3): 163-8. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1728-59172011000300008&lng=es
20. Amaru R, Quispe T, Torres G, Mamani J, Aguilar M, Miguez H, et al. Caracterización clínica de la eritrocitosis patológica de altura. Rev Hematol Mex. 2016 [acceso: 16/01/2022]; 17(1): 8-20. Disponible en: https://www.medigraphic.com/pdfs/hematologia/re-2016/re161c.pdf
21. Hurtado A, Plata R, Cornejo A, Mas G, Carbajal L, Sharma S, Swenson ER, et al. Higher prevalence of unrecognized kidney disease at high altitude. J Nephrol. 2018; 31(2): 263-9. DOI: 10.1007/s40620-017-0456-0
22. Hurtado A, Fuquay R, Sirota J, Swenson ER, Schoene RB, Jefferson JA, et al. High altitude renal syndrome (HARS). J Am Soc Nephrol. 2011; 22(11): 1963-8. DOI: 10.1681/ASN.2010121316
23. Chen W, Liu Q, Wang H, Chen W, Johnson RJ, Dong X, et al. Prevalence and risk factors of chronic kidney disease: a population study in the Tibetan population. Nephrol Dial Transpl. 2011; 26(5): 1592-9. DOI: 10.1093/ndt/gfq608
24. Brookhart MA, Schneeweiss S, Avorn J, Bradbury BD, Rothman KJ, Fischer M, et al. The effect of altitude on dosing and response to erythropoietin in ESRD. J Am Soc Nephrol. 2008; 19: 1389-95. DOI: 10.1681/ASN.2007111181
25. Brookhart MA, Bradbury BD, Avorn J, Schneeweiss S, Winkelmayer WC. The effect of altitude change on anemia treatment response in hemodialysis patients. Am J Epidemiol. 2011; 173:768-77. DOI: 10.1093/aje/kwq423
26. Sibbel S, Maroni B, Brunelli S. The effect of altitude on erythropoiesis-stimulating agent dose, hemoglobin level, and mortality in hemodialysis patients. J Nephrol. 2017; 30:821-829. DOI: 10.1007/s40620-016-0350-1
27. Hurtado A, Palacios A, Figueroa J, Gónzalez-Polar J, Kaluguina A, Lopera M. Niveles de hemoglobina en pacientes en hemodiálisis a nivel del mar y a mayor altitud, y su relación con la calidad de vida. Rev Soc Peru Med Interna. 2013 [acceso: 18/01/2022]; 26(4): 171-7. Disponible en: http://revistamedicinainterna.net/index.php/spmi/article/view/211
28. Rosales-Mendoza K, Gonzales-Polar J, Sumen R, Vizcarra C, Hurtado-Aréstegui A. Saturación de oxígeno en pacientes durante hemodiálisis a diferentes altitudes. Acta Med Peru. 2021; 38(3):193-8. DOI: 10.35663/amp.2021.383.2146
29. Lee DH, Min JH, Bae SB, Gil HW, Yang JO, Lee EY, Hong SY. Idiopathic erythrocytosis in a patient on chronic hemodialysis. Kidney Res Clin Pract. 2015; 34(1):60-3. DOI: 10.1016/j.krcp.2014.09.004
30. Sheqwara J, Alkhatib Y, Dabak V, Kuriakose P. Idiopathic erythrocytosis in dialysis patients: a case report and literature review. Am J Nephrol. 2013; 37:333-8. DOI: 10.1159/000349927
Published
2022-05-20
How to Cite
1.
Vizcarra Vizcarra CA. Polycythemia in patients with chronic kidney disease in hemodialysis. Rev Cubana Med Milit [Internet]. 2022 May 20 [cited 2025 May 10];51(2):e02201852. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/1852
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