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Haematological profile of chronic kidney disease in a mixed-ancestry South African population: a cross-sectional study
  1. Cindy George1,
  2. Tandi E Matsha2,
  3. Rajiv T Erasmus3,
  4. Andre P Kengne1,4
  1. 1 Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
  2. 2 Department of Biomedical Sciences, Faculty of Health and Wellness Science, Cape Peninsula University of Technology, Cape Town, South Africa
  3. 3 Division of Chemical Pathology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
  4. 4 Department of Medicine, University of Cape Town, Cape Town, South Africa
  1. Correspondence to Dr Cindy George; cindy.george{at}mrc.ac.za

Abstract

Objectives The objectives were to characterise the haematological profile of screen-detected chronic kidney disease (CKD) participants and to correlate the complete blood count measures with the commonly advocated kidney function estimators.

Methods The current cross-sectional study used data, collected between February 2015 and November 2016, of 1564 adults of mixed-ancestry, who participated in the Cape Town Vascular and Metabolic Health study. Kidney function was estimated using the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, and anaemia as haemoglobin level <13.5 g/dL (men) and <12 g/dL (women).

Results Based on the MDRD and CKD-EPI equations, the crude prevalence of CKD was 6% and 3%. Irrespective of the equation used, median red blood cell (RBC) indices were consistently lower in those with CKD compared with those without CKD (all p<0.0001). Despite not showing any significant difference in total white blood cell (WBC) count between the two groups, the number of lymphocytes were lower (p=0.0001 and p<0.0001 for MDRD and CKD-EPI, respectively) and neutrophil count (both p<0.0297) and the ratio of lymphocytes to neutrophil (both p<0.0001) higher in the CKD group compared with those without CKD; with the remaining WBC indices similar in the two groups. The platelet count was similar in both groups. Of the screen-detected CKD participants, 45.5% (MDRD) and 57.8% (CKD-EPI) were anaemic, with the prevalence increasing with increasing severity of CKD, from 37.2% (stage 3) to 82.4% (stages 4–5). Furthermore, CKD-EPI-estimated kidney function, but not MDRD, was positively associated with RBC indices.

Conclusion Though it remains unclear whether common kidney function estimators provide accurate estimates of CKD in Africans, the correlation of their estimates with deteriorating RBC profile, suggests that advocated estimators, to some extent approximate kidney function in African populations.

  • Africa
  • haematology
  • chronic kidney disease

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Footnotes

  • Contributors Study conception and funding acquisition: TEM, APK, RTE. Operationalisation and supervision of the data collection: TEM. Data analysis and interpretation: CG, APK. Drafting the manuscript: CG, APK. Critical revision of the manuscript and approval of the final version: all coauthors.

  • Funding The South African Medical Research Council (SAMRC) funded this research project with funds from National Treasury under its Economic Competitiveness and Support Package (MRC-RFA-UFSP-01-2013/VMH Study).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The study was approved by the Research Ethics Committees of the Cape Peninsula University of Technology and Stellenbosch University (NHREC: REC—230 408–014 and N14/01/003, respectively). The study was conducted in accordance with the Declaration of Helsinki. Permission to conduct the study was also obtained from relevant authorities including the city and community authorities.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

  • Presented at Poster presented at the 28th European Meeting on Hypertension and Cardiovascular Protection, held in Barcelona, 8–11 June 2018. As such, the results have been published as an abstract.

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