title: Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study.
abstract: Anemia, a common complication of chronic kidney diseases (CKD), is involved in significant cardiovascular morbidity. Therefore, the objective of our study was to investigate the prevalence and severity of anemia in pre-dialysis patients, as well as to determine the predictors of anti-anemic therapy.
  A retrospective, observational study was conducted on adult pre-dialysis patients receiving treatment at the Hospital Universiti Sains Malaysia from January 2009 to December 2013.
  A total of 615 eligible cases were included. The mean age of patients was 64.1±12.0 years. The prevalence of anemia was 75.8%, and the severity of anemia was mild in 47.7% of the patients, moderate in 32.2%, and severe in 20%. Based on morphological classification of anemia, 76.9% of our patients had normochromic-normocytic anemia whereas 21.8 and 1.3% had hypochromic-microcytic anemia and macrocytic anemia, respectively. Oral iron supplements were prescribed to 38.0% of the patients and none of the patients was given erythropoietin stabilizing agents (ESA) or intravenous iron preparations. In logistic regression, significant predictors of anti-anemic preparation use were decreased hemoglobin and hematocrit, and advanced stages of CKD.
  The results of the present study suggest that the prevalence of anemia in pre-dialysis patients is higher than currently accepted and it is found to be correlated with renal function; prevalence increases with declined renal function. An earlier identification as well as appropriate management of anemia will not only have a positive impact on quality of life but also reduce hospitalizations of CKD patients due to cardiovascular events.
authors.affiliation: PharmD, MSc. Doctoral Student, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia. Lecturer, University College of Pharmacy, University of the Punjab, Lahore, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Salman
authors.affiliation: BPharm, MPhil, PhD. Senior Lecturer, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, USM, Penang, Malaysia.
authors.forename: Amer Hayat
authors.initials: AH
authors.lastname: Khan
authors.affiliation: MD, MMed, FASN. Associate Professor, Chronic Kidney Disease Resource Centre, School of Medical Sciences, USM, Health Campus, Kota Bharu, Kelantan, Malaysia.
authors.forename: Azreen Syazril
authors.initials: AS
authors.lastname: Adnan
authors.affiliation: BPharm, PharmD. Full Professor, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, USM, Penang, Malaysia.
authors.forename: Syed Azhar Syed
authors.initials: SA
authors.lastname: Sulaiman
authors.affiliation: BPharm, MPhil, PhD. Full Professor, University College of Pharmacy, University of the Punjab, Lahore, Pakistan.
authors.forename: Khalid
authors.initials: K
authors.lastname: Hussain
authors.affiliation: PharmD, MPhil. Doctoral Student, University College of Pharmacy, University of the Punjab, Lahore, Pakistan.
authors.forename: Naureen
authors.initials: N
authors.lastname: Shehzadi
authors.affiliation: BPharm, MPhil, PhD. Lecturer, University College of Pharmacy, University of the Punjab, Lahore, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Islam
authors.affiliation: MD, MMed. Lecturer, Department of Gynecology and Obstetrics, School of Medical Sciences, USM, Health Campus, Kota Bharu, Kelantan, Malaysia.
authors.forename: Fauziah
authors.initials: F
authors.lastname: Jummaat
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D007668:Kidney / Q000502:physiology* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D006435:Renal Dialysis; D012189:Retrospective Studies; D017678:Sex Distribution; D012737:Sex Factors