Type of anemia correlate with ferritin levels in patients with Chronic Kidney Disease (CKD): a cross sectional study

Linda Rosita , Nurrin Jannatin, Barkah Djaka Purwanto, Tri Ratnaningsih, Usi Sukorini, Zulkifli Supranto Simanjuntak, Rahma Yuantari

Linda Rosita
Department of Clinical Pathology, Universitas Islam Indonesia, Yogyakarta, Indonesia. Email: [email protected]

Nurrin Jannatin
Faculty of Medicine, Universitas Islam Indonesia, Yogyakarta, Indonesia

Barkah Djaka Purwanto
Department of Internal Medicine, Faculty of Medicine, Universitas Ahmad Dahlan, Bantul, Yogyakarta, Indonesia

Tri Ratnaningsih
Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

Usi Sukorini
Department of Clinical Pathology and Laboratory Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

Zulkifli Supranto Simanjuntak
Doloksanggul District Hospital, North Sumatera, Indonesia

Rahma Yuantari
Department of Clinical Pathology, Universitas Islam Indonesia, Yogyakarta, Indonesia
Online First: September 15, 2021 | Cite this Article
Rosita, L., Jannatin, N., Purwanto, B., Ratnaningsih, T., Sukorini, U., Simanjuntak, Z., Yuantari, R. 2021. Type of anemia correlate with ferritin levels in patients with Chronic Kidney Disease (CKD): a cross sectional study. Bali Medical Journal 10(3): 867-871. DOI:10.15562/bmj.v10i3.2418

Background: Anemia is the most common complication due to CKD. Normocytic normochromic is the most common type of anemia in CKD is, but there is also some microcytic hypochromic. Clinical examination such as erythrocyte indices examination and monitoring serum ferritin levels can help diagnose anemia in CKD. The purpose of this study is to determine the correlation between erythrocyte indices and ferritin levels in CKD patients in the hemodialysis unit of PKU Hospital Bantul.

Methods: This research involved 50 CKD patients at PKU Hospital Bantul. Blood samples were taken to check ferritin levels and erythrocyte indices consisting of mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC). This study was conducted by cross-sectional study design. Data were analyzed using SPSS version 20 for Windows.

Results: The average hemoglobin level was 8.46±1.31 g/dL in males and 7.92±0.90 g/dL in females. Most of the hematological profile was predominant in male patients such as in MCV (89.36±6.72 fl), MCH (29.12±2.76 pg), and MCHC (32.95±0.96 g/dL). However, the average ferritin level (352.51±544.74 ng/mL) was predominant in female patients (399.99±680.96 ng/mL). There was a significant correlation between MCH and ferritin levels (r = 0.364; p = 0.009) and MCHC with ferritin levels (r = 0.295; p = 0.038). However, there was no significant correlation between MCV and ferritin levels (r = -0.059, p = 0.683).

Conclusion: There is a significant correlation between MCH and MCHC levels with ferritin levels. In addition, the patients had normal MCV, MCH, and MCHC values with normocytic normochromic anemia. 


Crews DC, Bello AK, Saadi G; for the World Kidney Day Steering Committee. Burden, Access, and Disparities in Kidney Disease. Blood Purif. 2019;48(1):32-39.

Neuen BL, Chadban SJ, Demaio AR, Johnson DW, Perkovic V. Chronic kidney disease and the global NCDs agenda. BMJ Glob Health. 2017;2(2):e000380.

Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005;67(6):2089-100.

Vadakedath S, Kandi V. Dialysis: A Review of the Mechanisms Underlying Complications in the Management of Chronic Renal Failure. Cureus. 2017;9(8):e1603.

Babitt JL, Lin HY. Mechanisms of anemia in CKD. J Am Soc Nephrol. 2012;23(10):1631-1634.

Sundhir N, Joshi S, Adya CM, Sharma R, Garg H. Profile of Anemia in Chronic Kidney Disease Patients at a Rural Tertiary Care Centre: A Prospective Observational Study. International Journal of Contemporary Medical Research. 2018;5(5):E30-E33.

Zadrazil J, Horak P. Pathophysiology of anemia in chronic kidney diseases: A review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015;159(2):197-202.

Shastry I, Belurkar S. The Spectrum of Red Blood Cell Parameters in Chronic Kidney Disease : A Study of 300 Cases. Journal of Applied Hematology. 2019;10(2):61–66.

Neomia LM, Carmen VL. Feritin: Could Be a Health Indicators. Journal of Family Medicine and Disease Prevention. 2018;4(2):1-8.

Bhatta S, Aryal G, Kafle RK. Anemia in chronic kidney disease patients in predialysis and postdialysis stages. Journal of Pathology of Nepal. 2011;1(1):26–29.

Dmitrieva O, de Lusignan S, Macdougall IC, Gallagher H, Tomson C, Harris K, et al. Association of anaemia in primary care patients with chronic kidney disease: cross sectional study of quality improvement in chronic kidney disease (QICKD) trial data. BMC Nephrol. 2013;14:24.

DeLoughery TG. Microcytic anemia. N Engl J Med. 2014;371(14):1324-1331.

Salama MAS, Kamal MY, Younan DNA, Henish GAA. Hypochromic microcytic anemia: a clincopathological cross- sectional study. Alexandria Journal of Pediatrics. 2017;30(1):37-43.

Mohamed EB, Ali EW. Evaluation of Haematological Parameters in Sudanese Haemodialysis Patients Treated with Recombinant Erythropoietin. European Academic Research. 2014;2(6):8065–8074.

Herawati S, Kandarini Y, Prabawa IPY. The Correlation between Estimated Glomerular Filtration Rate and Parathyroid Hormone Levels in Predialysis-chronic Kidney Disease Adult Patients at Sanglah General Hospital, Bali, Indonesia. Open Access Macedonian Journal of Medical Sciences. 2021;9(B):470-474.

Fehr T, Ammann P, Garzoni D, Korte W, Fierz W, Rickli H, et al. Interpretation of erythropoietin levels in patients with various degrees of renal insufficiency and anemia. Kidney Int. 2004;66(3):1206-11.

Nemeth E, Ganz T. Anemia of inflammation. Hematol Oncol Clin North Am. 2014;28(4):671-681.

de Montalembert M, Bresson JL, Brouzes C, Ruemmele FM, Puy H, Beaumont C. Diagnosis of hypochromic microcytic anemia in children. Arch Pediatr. 2012;19(3):295-304.

Iyawe IO, Adejumo OA, Iyawe LI, Oviasu EO. Assessment of iron status in predialysis chronic kidney disease patients in a Nigerian Tertiary Hospital. Saudi J Kidney Dis Transpl. 2018;29(6):1431-1440.

Tiwari M, Kotwal J, Kotwal A, Mishra P, Dutta V, Chopra S. Correlation of haemoglobin and red cell indices with serum ferritin in Indian women in second and third trimester of pregnancy. Med J Armed Forces India. 2013;69(1):31-36.

Takasawa K, Takaeda C, Maeda T, Ueda N. Hepcidin-25, mean corpuscular volume, and ferritin as predictors of response to oral iron supplementation in hemodialysis patients. Nutrients. 2014;7(1):103-118.

Lynn KL, Mitchell TR, Shepperd J. Red cell indices and iron stores in patients undergoing haemodialysis. Br Med J (Clin Res Ed). 1981;282(6282):2096.

Higgins C. Full blood count (RBC, Hb, PCV, MCV, MCH and reticulocytes). Nurs Times. 1995;91(7):38-40.

Zain H, Ratnaningsih T, Puspitawati I. Korelasi Indeks Eritrosit dengan Kadar Feritin Serum pada Pasien Gagal Ginjal Kronik di Unit Hemodialisis RSUP DR Sardjito [Bachelor Thesis]. Faculty of Medicine Universitas Gadjah Mada. 2016.

No Supplementary Material available for this article.
Article Views      : 0
PDF Downloads : 0