Association Between Hemolysis Markers and Renal Dysfunction in Hemodialysis Patients A Bilirubin Based Retrospective Study

Background : Acute renal failure (ARF) and chronic renal failure (CRF) are associated with significant hematological disturbances, particularly anemia and hemolysis, in patients undergoing hemodialysis. Mechanical stress during dialysis, accumulation of uremic toxins, and metabolic imbalances contribute to red blood cell (RBC) damage. However, data on hemolysis-related parameters among renal failure patients in Yemen remain scarce. Objective: To evaluate hemolysis-associated hematological parameters and their relationship with renal dysfunction in ARF and CRF patients undergoing hemodialysis in Hodeidah, Yemen. Methods: A retrospective analytical study was conducted on 52 renal failure patients undergoing hemodialysis during 2022. Hematological parameters (hemoglobin, hematocrit, mean corpuscular hemoglobin concentration) and biochemical indicators (serum creatinine, total bilirubin, hemolysis percentage) were measured using standardized hematology and biochemical analyzers. Statistical analysis included independent t-tests, Pearson correlation, and linear regression models, with significance set at p < 0.05. Results: CRF patients exhibited significantly higher serum creatinine (8.15 ± 1.85 mg/dl), total bilirubin (13.95 ± 5.55 mg/dl), and hemolysis percentage (32.05 ± 12.65%) compared with ARF patients (6.55 ± 4.15 mg/dl, 1.1 ± 0.9 mg/dl, and 1.3 ± 0.88%, respectively; p < 0.01). Hemoglobin and hematocrit values were lower in CRF patients (7.55 ± 0.75 g/dl and 25.3 ± 2.5%) than in ARF patients (8.95 ± 3.15 g/dl and 29.9 ± 10.5%; p < 0.05). Serum creatinine correlated positively with hemolysis (r = 0.61, p < 0.01), while hemoglobin and hematocrit showed negative correlations. These findings not only highlight laboratory abnormalities but also suggest potential clinical consequences such as increased transfusion requirements and altered erythropoietin dosing. Linear regression analysis demonstrated that serum creatinine was a significant predictor of hemolysis percentage (β = 2.85, p < 0.01), explaining approximately 58% of the variance in hemolysis levels (R² = 0.58). Conclusion: Hemolysis-related hematological abnormalities are significantly elevated in CRF patients compared with ARF patients. These findings suggest that worsening renal dysfunction is strongly associated with increased RBC destruction. Routine monitoring of hemolysis indicators alongside standard hematological tests may improve early detection and management of hematological complications in dialysis patients, particularly in resource-limited settings.