Changes in haematological parameters in relation to the stage of chronic kidney disease in a cohort of patients receiving care at Teaching Hospital Karapitiya, Galle, Sri Lanka

The incidence and prevalence of chronic kidney disease is rising in Sri Lanka. This study aimed to evaluate the degree and type of anaemia, erythrocyte sedimentation rate, thrombocytopenia, hypersegmented neutrophils, and burr cells in patients with chronic kidney disease across different stages. A descriptive cross-sectional study was conducted at Teaching Hospital Karapitiya, enrolling 114 CKD patients: 49 in stages 3 & 4, 26 in stage 5 non-dialysis, and 39 on haemodialysis. Data was collected via questionnaires and routine full blood counts. Anaemia was present in 82.3% of the cohort, with a mean haemoglobin of 10.61 g/dL. Prevalence rates were 75.5% in stages 3 & 4, 76.9% in stage 5 nondialyzed and 94.7% in haemodialyzed patients. Haemoglobin levels in patients on haemodialysis were significantly lower by 2.4 g/dL compared to stages 3 & 4 and 1.86 g/dL compared to stage 5 non-dialyzed patients. (P<0.001). Normochromic normocytic anaemia was the most common (82.3%), while hypochromic microcytic anaemia was found in 16.8% overall and 42.1% of dialyzed patients. Thrombocytopenia affected 18% of patients, where prevalence increased from 10.2%in stages 3 & 4 to 25.6% in dialyzed patients. Moderate thrombocytopenia was seen only in dialyzed patients (10.3%), with their significantly lower mean platelet count, compared to stages 3 & 4 (P=0.04). Elevated ESR occurred in 75.2%, which increased with disease progression without statistical significance. Markedly elevated ESR (>100 mm/ hr) was observed in 3.53 % of patients. Hypersegmented neutrophils were present in all patients, being highest in stage 5 nondialyzed (P=0.001) and next in dialyzed patients (P=0.004). Burr cells increased with CKD progression without statistical significance.