Anaemia and endoscopic gastroduodenitis in pre-dialysis patients

The extent of pre-dialysis anaemia in Asian patients and the contribution of gastrointestinal blood loss to anaemia are unknown. Of 76 new dialysis patients in our unit in 1994, 7.9% of patients had a haemoglobin (Hb) < 6 g/dL; 53.9% had Hb greater than or equal to 6 - < 8 g/dL; 28.9% had an Hb greater than or equal to 8 - < 10 g/dL and 9.2% had Hb greater than or equal to 10 g/dL in the 2 months before dialysis. Gastroduodenoscopy in 38 patients 2 months pre-dialysis (excluding 1 patient each with chronic duodenal ulcer and overt haemorrhagic gastritis), showed that 16.7% were normal, while the rest had mucosal erythema, erosions or petechiae alone or in combination. Haemoglobin was significantly lower in patients with endoscopic petechiae (n = 23, Hb 7.24 +/- 1.28 g/dL) compared with those without (n = 13, Hb 8.35 +/- 1.29 g/dL), although preceding blood transfusions were similar. No differences in Hb were noted in patients with or without endoscopic erythema or erosions, respectively. It is possible that occult blood loss associated with gastroduodenal petechiae exacerbates anaemia in chronic renal failure (CRF).