The Relationship Between Oxidative Stress and Hematological Parameters in Ghanaian Patients With Chronic Kidney Disease

Abstract

Abstract Background Chronic kidney disease (CKD) is a major cause of morbidity and mortality worldwide with a rising burden in sub-Saharan Africa. Evidence from previous studies suggest high oxidative stress levels in CKD patients. Anti-oxidative enzymes such as superoxide dismutase (SOD) are impaired in kidney disease. Oxidative stress situations result in red blood cell dysfunction, platelet destruction and tissue injury. In this study we investigated hematological indices and superoxide dismutase activity during CKD. Methods The study utilized a cross-sectional design consecutively recruiting patients attending the Renal Unit of Korle-Bu Teaching Hospital (KBTH), Accra, with known CKD (n = 41). Healthy subjects (n = 41) from the Outpatients Department (KBTH) were recruited as controls. Blood samples were collected to determine hematological indices. The oxidative stress level in cases and control groups were determined by measuring superoxide dismutase enzyme activity. A diagnostic predictability analysis was also performed for the various parameters measured in this work. Results SOD activity level was significantly lower in CKD patients than in the control group (p < 0.0001). Red blood cell (r = 0.299; p = 0.039) hemoglobin (r = 0.383; p = 0.001) and hematocrit (r = 0.306; p = 0.005) correlated positively with SOD activity in cases compared with control group. Patients with CKD had significantly higher numbers of white blood cells (p < 0.0001), neutrophils (p < 0.0001) and lymphocytes (p = 0.0001) comparing with controls. White blood cell (WBC) (r= -0.331; p = 0.002), platelet levels (r= -0.234; p = 0.034) and neutrophil level (r= -0.238; p = 0.031) correlated negatively with SOD activity. In predicting CKD, SOD activity had sensitivity of 66% and specificity of 100% while WBC had higher sensitivity of 76% and comparable specificity of 90%. Conclusion SOD activity correlated negatively with total white blood cell, neutrophils and platelets. Red blood cells, hemoglobin concentration, and hematocrit indices had positive correlation with SOD activity. Both SOD and WBC had high specificity, 100% and 90%, respectively for the occurrence of CKD. In predicting CKD, WBC had a relatively higher sensitivity to SOD and could play a role in risk stratifying patients in resource-limited settings.