FREQUENCY OF MEGALOBLASTIC ANEMIA AMONG PATIENTS WITH CHRONIC KIDNEY DISEASE: A CROSS-SECTIONAL STUDY FROM A TERTIARY CARE HOSPITAL IN PAKISTAN

Abstract

Background

Chronic kidney disease (CKD) is a major global public health problem associated with significant morbidity and mortality. Anemia is one of the most common complications of CKD and contributes substantially to reduced quality of life and increased cardiovascular risk. While anemia related to erythropoietin deficiency and iron deficiency has been extensively studied, megaloblastic anemia resulting from vitamin B12 or folate deficiency remains relatively under-investigated among CKD patients. Identifying the burden of megaloblastic anemia in CKD is clinically important because it represents a potentially reversible cause of anemia. However, limited data are available regarding its frequency in the Pakistani population.

Objective

To determine the frequency of megaloblastic anemia among patients with chronic kidney disease presenting to a tertiary care hospital.

Methods

This cross-sectional study was conducted in the Department of Medicine at Qazi Hussain Ahmad Medical Complex, Nowshera, Khyber Pakhtunkhwa, Pakistan, over a period of six months from November 2024 to April 2025. A total of 180 patients aged 20–70 years with diagnosed chronic kidney disease were enrolled using a non-probability consecutive sampling technique. Demographic and clinical data including age, gender, socioeconomic status, diabetes mellitus, hypertension, smoking status, obesity, and stage of CKD were recorded using a structured proforma. Laboratory investigations included complete blood count and peripheral blood smear examination. Megaloblastic anemia was defined as hemoglobin level <10 g/dL with mean corpuscular volume (MCV) >100 fL along with characteristic peripheral smear findings. Data were analyzed using SPSS version 22. Descriptive statistics were used to summarize the data, and the chi-square test was applied to assess associations between megaloblastic anemia and potential effect modifiers. A p-value ≤0.05 was considered statistically significant.

Results

A total of 180 patients with chronic kidney disease were included in the study. The mean age of participants was 48.36 ± 9.59 years, and 53.3% were male. The mean hemoglobin level was 10.39 ± 1.46 g/dL and the mean MCV was 91.70 ± 9.78 fL. Hypertension was the most common comorbidity, present in 66.7% of patients, followed by diabetes mellitus in 42.2%. The majority of patients presented with advanced stages of CKD, with 31.1% in stage V and 30.0% in stage IV. Megaloblastic anemia was identified in 30 patients, representing a frequency of 16.7%. Stratification analysis showed no statistically significant association between megaloblastic anemia and gender, residence, socioeconomic status, diabetes mellitus, hypertension, smoking status, obesity, or stage of CKD (p > 0.05).

Conclusion

Megaloblastic anemia was present in a notable proportion of patients with chronic kidney disease in this study population. Although no significant associations with demographic or clinical factors were identified, the findings highlight the importance of considering nutritional causes of anemia in CKD patients. Routine hematological evaluation may facilitate early detection and management of potentially reversible causes of anemia, thereby improving patient outcomes.