Hematological Changes in Total and Differential Count in Pre and Post Hemodialysis of Adult Chronic Kidney Disease Patients

Background: Hematologic abnormality, especially anemia, and changes in total and differential blood counts are mostly observed with this condition. Advanced CKD patients undergo hemodialysis as a standard treatment, and consequently, the parameters go along with these patients. Acquiring the relevant changes will help in improving patient management and complications arising from CKD. Objective: To evaluate the change in total and differential blood counts in adult CKD patients before and after hemodialysis, especially as it concerns levels of hemoglobin, hematocrit, red blood cells, white blood cells, platelets, and differential count (neutrophils, lymphocytes, monocytes, eosinophils). Methods: A prospective observational study was conducted at Kisii Teaching and Referral Hospital, Kenya, on 120 adult chronic kidney disease patients on hemodialysis. Blood samples were taken before the start of the dialysis session (pre-hemodialysis) and taken within 30 minutes after the dialysis session (post-hemodialysis). Automated hematology analyzer performed all necessary hematological analysis that included total blood count and differential blood count. The data were analyzed using SPSS version 26. Pre- and post-hemodialysis values were compared with t tests for paired samples or Wilcoxon signed-rank tests. Results: The mean hemoglobin concentration increased significantly from a baseline value of 8.4 ± 1.9 g/dL pre-hemodialysis to a post-hemodialysis concentration of 10.1 ± 2.1 g/dL (p < 0.001). Hematocrit and red blood cell counts also increased considerably (p < 0.01). White blood cell counts dropped significantly from 8.5 ± 3.4 × 10³ cells/μL pre-hemodialysis to 7.3 ± 2.8 × 10³ cells/μL post-hemodialysis (p = 0.004). The platelet count also fell from 270 ± 82 × 10³ cells/μL pre-hemodialysis to 248 ± 75 × 10³ cells/μL post-hemodialysis (p = 0.03). Neutrophil percent decreased while lymphocyte percent increased significantly post-hemodialysis (p = 0.01 and p = 0.02 respectively). Conclusion: Hemodialysis is shown to significantly improve hemoglobin, hematocrit, and red blood cell counts in adult patients who have chronic kidney disease. However, hemodialysis reduces white blood cell and platelet counts in adult chronic kidney disease patients. These modifications in hematology may have been of benefits of the clearance of uremic toxins and the reduced inflammation during dialysis. Certain of these modifications, like anemia or changes in platelets, persist beyond the process, establishing the need for further management of hematological manifestations in chronic kidney disease patients. Long-term studies are also encouraged to cover the extent of the effects of dialysis on hematological and immune functions among chronic kidney disease patients.