Iron Deficiency Anemia With Low Hemoglobin Levels Are Predictor Of Mortality in Patients with Chronic Kidney Disease

Abstract

Iron deficiency anemia (IDA) is a frequent complication in patients with chronic kidney disease (CKD) and is linked to high mortality rates. Iron is essential for hemoglobin (Hb) synthesis, and disturbances in iron balance can result in iron deficiency anemia. This study aims to investigate the association between hemoglobin levels, iron status, and mortality rates in patients with anemia on chronic kidney disease. This study is a retrospective cohort study in a hemodialysis (HD) unit in Central Java, Indonesia, followed by one year of monitoring until the patient died or dropped out of HD. Survival rate was analyzed using Kaplan-Meier and Log-rank test. Cox proportional hazard regression was used to calculate the hazard ratio. There were 33 patients who met the study criteria. The patients with anemia on CKD have a 75.7% one-year survival. The survival rates of patients with Hb < 10g/dl vs Hb ≥ 10g/dL are 75% vs 80% in one year (p = 0.771), while Hb < 10 g/dL is not a predictor of mortality (HR = 1.520, 95% CI 0.186 – 12.457). The one-year survival rate of patients with IDA vs non-IDA is 50% vs 82% (p = 0.072), while IDA is not increasing mortality (HR = 3.463, 95% CI 0.819 – 14.648). The specific group of Hb < 10g/dl and IDA has significantly lower survival rates than Hb ≥ 10g/dL or non-IDA (40% vs 82%, p = 0.021). The Hb < 10 g/dl and IDA group also has 4.5-fold higher mortality than the other group (HR = 4.527, 95% CI 1.071 – 19.124). CKD patients with Hb lower than 10g/dl and IDA have 4.5-fold higher mortality than CKD patients with Hb higher than 10g/dL or non-IDA. Hemoglobin levels lower than 10g/dl and IDA are predictors of mortality in patients with anemia on CKD