Introduction:
Anemia is a common complication in ESKD. However, in resource limited countries such as Cameroon, the use of erythropoiesis stimulating agent (ESA) is low and blood transfusion is still the main treatment of anemia in such patients. Polytransfusion may lead to hyperferritinemia which is known to increase morbi-mortality in hemodialysis. We sought to evaluate the prevalence, and the factors associated to hyperferritinemia in a hemodialysis facility in Cameroon.
Methods:
We conducted a prospective cohort study at the hemodialysis (HD) unit of the Douala General Hospital, from 1st January to 31st May 2023. We included all adult patients on HD for ≥ 6 months, without intercurrent pathologies, no acute infection and not admitted during the last 4 weeks. We collected sociodemographic, clinical, biological data as well as 5ml of pre-dialysis blood per patient for an automated URIT3000 plus haemogram and ferritin determination by the ELISA method. Serum ferritin >500ng/l was considered as hyperferritinemia. Patients were then follow-up for 1 year and death as well as major cardiovascular event was recorded as poor outcome. Significant values were defined by p˂0.05.
Results:
A total of 98 participants (54 males) were included with a mean age of 46.5 years ± 15.24. Mean hemodialysis vintage was 4.5±3.8 years. HIV and HBV/HCV were found in 8.2% (n=8) and 10.2% (n=10) of patients. Transfusion was the main treatment for anemia (72.5%, n=71) with a median monthly transfused bags of 3[2-4]. Half (n=49) of patients received regular dose of IV iron and 34.7% (n=34) used erythropoietin regularly but only 12 of them were only on ESA without transfusion. Mean Hemoglobin level was 8.13±1.6g/dl and 69.4% of patient had hemoglobin level <9g/dl. Mean ferritin level was 466.4±187.55ng/l and hyperferritinemia was found in 61.2% (n=60) of patients. In univariate analysis, the factors associated with hyperferritinemia were age >50 years (p=0.025), marital status (p=0.005), number of blood bags received per month (p=0.002), erythropoietin (p=0.01) and iron supplementation (p=0.02). In multivariate analysis, only the number of blood bags transfused ≤ 3 bags/month (OR= 0.18 [0.06-0.55]; p=0.003) was protective factor for hyperferritinemia. After 1 year of follow-up, poor outcome was more common in patients with hyperferritinemia (36.6% (n=22) vs 13.15% (n=5), p=0.037).
Conclusions:
Hyperferritinemia in common in our setting and it is mainly link to polytransfusion. It may also be associated to worse outcome with increase death and cardiovascular events. Efforts should be made for more ESA availability.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.