Prevalence and Determinants of Anemia in Patients with Chronic Kidney Disease on Maintenance Hemodialysis

Background: Anemia is a frequent and multifactorial complication of chronic kidney disease, particularly among patients on maintenance hemodialysis, contributing significantly to morbidity, mortality, and reduced quality of life. Objective: To determine the prevalence of anemia and analyze its clinical, biochemical, and dialysis-related determinants among patients with chronic kidney disease receiving maintenance hemodialysis. Methods: This cross-sectional analytical study was conducted at the Department of Nephrology, Rajshahi Medical College Hospital, from July 2024 to December 2025. A total of 184 patients on maintenance hemodialysis were enrolled. Demographic, clinical, laboratory, and dialysis-related variables were recorded. Statistical analysis included descriptive statistics, comparative tests, and multivariable regression. Statistical significance was set at p < 0.05. Results: The mean age was 51.8 ± 12.6 years, with males comprising 61.4%. Anemia prevalence was 87.5% (n = 161), including mild (29.3%), moderate (41.8%), and severe anemia (16.4%). Mean hemoglobin was 9.2 ± 1.6 g/dL. Patients with diabetes showed significantly lower hemoglobin levels (8.8 ± 1.4 vs 9.6 ± 1.7 g/dL; p = 0.002). Iron deficiency (serum ferritin <200 ng/mL) was present in 38.6% (p = 0.01). Higher CRP levels correlated inversely with hemoglobin (r = −0.42, p < 0.001). Inadequate dialysis (Kt/V <1.2) was associated with higher anemia severity (p = 0.004). Multivariable analysis identified age ≥60 years, hypoalbuminemia, inflammation, and dialysis inadequacy as independent predictors. Conclusion: Anemia is highly prevalent among maintenance hemodialysis patients, driven by demographic, inflammatory, nutritional, and dialysis-related factors, underscoring the need for comprehensive and individualized anemia management strategies.