Abstract
Anemia is considered a common finding in dogs with chronic kidney disease (CKD), typically as normochromic, normocytic, and non-regenerative. Although anemia can occur at any CKD IRIS (International Renal Interest Society) stage, its severity is related with the loss of kidney function. The aim of the present study was to retrospectively evaluate quantitative and morphological abnormalities of the erythrogram in dogs at different CKD IRIS stages. A total of 482 CBCs from 3648 initially screened were included in the study. Anemia was present in 302/482 (63%) dogs, in the majority of which it was normochromic, normocytic, and non-regenerative (295/302; 98%). The number of reticulocytes was <60,000/μL in the majority of dogs (248/295; 84%), with a correlation between poor regeneration rate and progression of CKD (p = 0.0001). The frequency of anemia significantly differed (p = 0.0001) among the IRIS stages: 108/231 (47%) in IRIS 2, 77/109 (71%) in IRIS 3, and 117/142 (82%) in IRIS 4. Dogs at IRIS stages 3 and 4 were more likely to have moderate to severe anemia, compared to dogs at IRIS stage 2 (p = 0.0001). Anisocytosis was the most frequent morphological abnormality (291/482; 60%), whereas the presence of poikilocytosis showed an association with progression of IRIS stages (p = 0.009). Among different morphological abnormalities, the frequency of fragmented red blood cells and Howell–Jolly bodies showed a significant association with the progression of CKD. Anemia was a frequent finding in CKD dogs, mostly associated with none to poor regeneration rate. Similar to human medicine, advanced CKD stages are more frequently characterized by morphological alterations, such as fragmented red blood cells and Howell–Jolly bodies, which may suggest a more severe condition of reduced bone marrow activity and microangiopathy.
Highlights
Anemia is considered a common finding in dogs with chronic kidney disease (CKD) [1], which typically occurs as normochromic, normocytic, and non-regenerative [2]
Dogs were excluded if (1) historical, laboratory, and/or ultrasonographic findings were consistent with acute kidney injury (AKI); (2) there was a unavailable report of the blood smear evaluation; (3) use of alpha-darbepoetin or red blood cell transfusion prior to the presentation; (4) severe comorbidities, which might affect erythrogram, such as hyperadrenocorticism, hypothyroidism, and neoplasia; and (5) since the same dog was included in the case selection only once, rechecks of the same patients were excluded
The main mechanism of anemia in CKD has been historically recognized in erythropoietin (EPO) deficiency, which is responsible for poor maturation and differentiation of red blood cell (RBC) precursors
Summary
Anemia is considered a common finding in dogs with chronic kidney disease (CKD) [1], which typically occurs as normochromic, normocytic, and non-regenerative [2]. No published data are available regarding anemia in CKD dogs at different stages, clinical experiences seem to show an association between frequency of anemia and progression of CKD. The severity of anemia has been reported to correlate positively with serum creatinine concentrations [1] and to become clinically relevant in patients with CKD International Renal Interest Society (IRIS) stages 3 and 4 [4]. Morphological abnormalities of RBCs, such as spiculated (echinocyte) and deformed RBCs (acanthocytes), have been occasionally reported in the blood smear evaluation of CKD dogs, their association with the severity of CKD has not been investigated [2]. The aim of the present study was to retrospectively evaluate quantitative and morphological abnormalities of erythrogram in dogs at different CKD IRIS stages
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