Anemia in Chronic Kidney Disease (CKD)

CKD is the fifth leading cause of death in Egypt and, burden of CKD increased by 36% from 2009 -2019. Anemia is a common complication of CKD and is highly associated with adverse outcomes such as cardiovascular events and increased risk of hospitalization and mortality, it leads also to worsening of kidney function if untreated. Additionally, the severity of anemia correlates with decreased quality of life. This means more healthcare resources are being used to treat CKD patients with anemia comorbidity, which increases healthcare cost. Anemia is defined based on serum hemoglobin level; serum transferrin saturation (TSAT), an indicator of circulating iron; and serum ferritin, an indicator of stored iron.

Anemia is a common complication in (CKD)patients, with a multifactorial pathophysiology involving impaired erythropoiesis, decreased erythropoietin (EPO) production, dysregulated iron metabolism, blood loss, inflammation, nutritional deficiencies and oxidative stress. Recently it has been found that HIF-PHI play an important role in anemia management highly associated.

Among patients undergoing dialysis only 16 % have hemoglobin level between 12 and 12.9 g/dl, and 24% of them have hemoglobin between 10 and10.9 g/dl, and 23% have Hb between 9 to 9.9 g/dl, it is <9 g/dl in 23%. Despite 83% of patients undergoing dialysis being on erythropoietin.

Paradoxically, 22% and 26% of patients undergoing dialysis have transferrin saturation levels <20% and ferritin levels <200 ng/ml, respectively, whereas 39% of them are on intravenous iron treatment.

These data could signal that large proportions of hemodialysis patients in Egypt are undertreated for anemia The high cost of anemia treatment is a potential contributing factor to the high prevalence of anemia in patients on dialysis in Egypt.

Although the government issues a bundled credit toward medications for dialysis patients for E£150 per month, iron preparations (intravenous or oral) are fully covered in this bundle. Although the ESAs were suboptimal subsidized, most recently, the annual cost of ESA is subsidized by the government for E£3000 per year, which can cover the cost of ESA treatment for an entire year.

Treatment of anemia brings hope for better outcomes, and improve quality of life of these patients, decrease risk of hospitalization, cardiovascular complication and delay progression of CKD, therefor treatment of anemia is a cost effective