Changes in Tissue Erythropoietin and Some Haematological Parameters in Chronic Kidney Disease Subjects on Blood Transfusion in Port-Harcourt

Main Article Content

E. M. Eze
B. S. Mbeera
S. Ken-Ezihuo
G. N. Mbeera
S. O. Akwuebu

Abstract

Chronic kidney disease (CKD) is a progressive loss in renal function over a period of time. The kidney chiefly secretes erythropoietin (EPO) which is a glycoprotein hormone that acts on the bone marrow cells resulting in red blood cell formation. Anaemia is a major complication in CKD. The aim of this study was to assess changes in erythropoietin levels in chronic kidney disease patients on blood transfusion attending health care in Port Harcourt. A total of one hundred and fifty two (152) subjects were recruited for this study. One hundred and twenty two (122) subjects were recruited from those confirmed with renal diseases from the Urology Department of the hospital. Thirty eight (38) subjects were non-transfused with blood and eighty four (84) subjects were multitransfused with blood. Thirty subjects were apparently healthy controls. EPO was determined by sandwich ELISA method while the full blood count was determined using haematology autoanalyser, Mindray BC-6800..The results were statistically analyzed using GraphPad prism version 5.0 and statistical significance set at P<0.05. The result showed a significant decreased (p<0.0001) in EPO level in multitransfused and non-transfused subjects with mean values of 4.95±2.95 mIU/Land 6.32±2.66 mIU/L respectively compared to control 10.51±3.05 mIU/L. On assessment of the haematological characteristics, erythropoietin secretions of patients with chronic kidney disease (CKD), the mean haematocrit, haemoglobin, mean cell haemoglobn concentration and red cell count for the multiple transfused CKD were respectively found to be significantly lower compared to that of nontransfused. This could be due to impaired erythropoietin secretion and other factors which suppress marrow erythropoiesis  and shortened red cell survival in CKD which was directly associated with a decrease in red cell count and subsequent reduction in the haematocrit level. Transfusion improves anaemia through the increase in haemoglobin and hepcidin and as well suppresses erythropoiesis with an eventual decrease in erythropoietin and growth differentiation. It is therefore concluded that transfusion does not improve anaemia in CKD subjects.

Keywords:
Erythropoietin, chronic kidney disease, blood transfusion, Port-Harcourt

Article Details

How to Cite
Eze, E. M., Mbeera, B. S., Ken-Ezihuo, S., Mbeera, G. N., & Akwuebu, S. O. (2019). Changes in Tissue Erythropoietin and Some Haematological Parameters in Chronic Kidney Disease Subjects on Blood Transfusion in Port-Harcourt. Asian Hematology Research Journal, 2(2), 1-10. Retrieved from http://journalahrj.com/index.php/AHRJ/article/view/30104
Section
Original Research Article

References

Hoffbrand AV, Paul AHM. Haematological changes in systemic diseases. In Hoffbrand, A.V., Paul, A.H.M. (Eds.). Hoffbrand’s Essential Haematology. 7th Ed. Singapore: Willey Blackwell & Sons Ltd. 2016b;325-326.

Bijlani RI. Applied renal physiology. In Bijlani, R.I. (Ed). Understanding Medical Physiology. 3rd Ed. New Delhi: J.P Brothers. 2004;522-523.

Arogundade F, Barsoum R. CKD prevention in sub-Saharan Africa: A call for governmental, nongovernmental, and community support. American Journal of Kidney Disease. 2008;51:515-523.

Roderick P, Roth M, Mindell J. Prevalence of chronic kidney disease. In England: Findings from the 2009 Health Survey for England. Journal of Epidemiology and Community Health. 2011;65:12.

Charles EA. The kidney. In: Vinay, K., Abul, K.A. & Nelson, F. R. (Eds). Pathologic Basis of Disease. 7th Ed. Elsevier Incorporation. 2004;960-965.

Egbi OG, Okafor UH, Miebodei KE, Kasia BE, Kunle-Olowu OE, Unuigbe EI. Prevalence and correlates of chronic kidney disease among civil servants in Bayelsa state, Nigeria. Nigerian Journal of Clinical Practice. 2014;17:602-607.

Abramov D, Cohen RS, Katz SD, Mancini D, Maurer MS. Comparison of blood volume characteristics in anemic patients with low versus preserved left ventricular ejection fractions. American Journal of Cardiology. 2008;102(8):1069–1072.

Akinsola A, Durosinmi MO, Akinola NO. The haematological profile of Nigerians with chronic renal failure. African Journal of Medical Science. 2000;29(1):13-16.

Joseph F. White bloos cells and inflammation. Quantitative Human Physiology. 2012;2:1-2.

George J, Patal S, Wexler D. Circulating erythropoietin levels and prognosis in patients with congestive heart failure: Comparison with neurohormonal and inflammatory markers. Archives of Internal Medicine. 2005;165(11):1304–1309.

Adlbrecht C, Kommata S, Hülsmann M. Chronic heart failure leads to an expanded plasma volume and pseudoanaemia, but does not lead to a reduction in the body’s red cell volume. European Heart Journal. 2008;29(19):2343–2350.

Abefe SA, Abiola AF, Olubunmi AA, Adewale A. Utility of predicted creatinine clearance using MDRD formula compared with other predictive formulas in Nigerian patients. Saudi Journal of Kidney Disease Transplantation. 2009;20:86-90.

World Health Organization (WHO). Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. A review of vitamin and mineral nutrition information system. Geneva: World Health Organization; 2011 (WHO/NMH/NHD/MNM/11.1); 2018.

Ashby DR, Gale DP, Busbridge M, Murphy KG, Duncan D, Cairns TD, Taube DH, Bloom SR, Tam FW, Chapman R, Maxwell PH, Choi P. Erythropoietin administration in human causes a marked and prolonged reduction in circulating hepcidin. Haematologica. 2016;95(3):505-508.

Kidney Disease Improving Global Outcome (KDIGO). Clinical practice guideline of evaluation and management of CKD. Kidney International. 2012;3:1-150.

Cochran WG. Sampling techniques. 3rd Ed. New York: John Wiley & Sons; 1977.

Kenneth K, Marshall AL, Josef TP, Marcel ML, Oliver WP, Linda JB, Michael AC. Anaemia of chronic disease. In Kenneth, K., Marshall, A.L., Josef, T.P., Marcel, M.L., Oliver, W.P., Linda, J.B. & Michael, A.C. (Eds.). Williams Haematology. 9th Ed. New York: Mc Graw Hill Education Ltd. 2016;549-556.

Shenzhen M. Mindray Bio-Medical Electronics Co., Limited; 2017.

Chandra M. Pathogenesis of the anaemia of chronic renal failure: Therole of erythropoietin. Nefrologia. 1990;12-22.

Sant-Rayn P, David MF, Donald K, Bowden, Gregory JA. Transfusion supresses erythropoiesis and increases hepcidin in adult patients with β-thalassaemia major: A longitudinal study. Blood. 2013;122:124-133.

Muller-Esterl W. Fundamental of medicine and the science of life. Editorial Reverte. 2008;660.

Abdulrahaman Y, Osaro E, Uko EK, Isaac IZ, Bello Z, Liman HM. Packed cell volume, Reticulocyte count and index among patients with chronic kidney disease in Sokoto, North-western Nigeria. Journal of Medical and Health Sciences. 2013;2319-9865.

Mohammad A, Asmini S, Farukuzzaman MD, Abdul G, Farha MJ, Tanima S, Khokon KD, Mohammod JI. Assessment of red blood cell indices, white blood cells, platelet indices and procalcitonin of chronic kidney disease patients under haemodialysis. International Journal of Health Sciences and Research. 2018;8(8):98-109.

Macdougall IC, Geisser P. Use of intravenous iron supplementation in chronic kidney disease: An update. Iran Journal of Kidney Disease. 2013;7(1):9-22.

Palazzuoli A, Antonelli G, Nuti R. Anemia in cardio-renal syndrome: Clinical impact and pathophysiologic mechanisms. Heart Fail Reviews. 2011;16(6):603–607.

Halim NK, Famodu AA, Wemambu SN. Textbook of clinical haematology and immunology. 2nd Ed. Benin: Ambik Press; 2001.

Arun S, Prabhu MV, Chowta KN, Bengre ML. The haematological pattern of the patients with chronic kidney disease in a tertiary care setup in South India. Journal of Clinical Diagnosis and Research. 2012;6:1003-1006.

Kovesdy CP, George SM, Anderson JE, Kalantar-Zadeh K. Outcome predictability of biomarker of protein energy wasting and inflammation in moderate and advance chronic kidney disease. American Journal of Clinical Nutrition. 2009;90:407-414.

Cases-Amenós A, Martínez-Castelao A, Fort-Ros J, Bonal-Bastons J, Ruiz MP, Vallés-Prats M. Prevalence of anaemia and its clinical management in patients with stages 3–5 chronic kidney disease not on dialysis in Catalonia. Nefrologia. 2014;34:189-198.

Hutchinson C, Geissler CA, Powell JJ, Bomford A. Proton pump inhibitors suppress absorption of dietary non-haem iron in hereditary haemochromatosis. Gut. 2007;56(9);1291–1295.

Akban D, Mohammad M, Shadi T, Zaha KK, Gholam T, Esmaeil SM, Taregh B, Shaban A, Eshagh M. Anaemia and thrombopoietin in acute and chronic renal failure. International Journal of Haematology-Oncology and Stem Cell Research. 2013;7(4):34-39.

John TD, Angelito AB. Hemodialysis effect on platelet count and function and hemodialysis-associated thrombocytopenia. Kidney International. 2012;82(2):147-157.

Kenneth-Kaushansky MD. Lineage-specific haematopoietic growth factors. New England Journal of Medicine. 2006;354:2034-2045.

Weiss G, Goodnough LT. Anaemia of chronic disease. New England Journal of Medicine. 2005;52:1011- 1023.

Asfar R, Sanavi S, Salimi I, Ahmadzadeh M. Hematological profile of chronic kidney disease in Iran, in predialysis stages and after initiation of hemodialsysis. Saudi Journal of Kidney Disease Transplantation. 2010;21,368-371.