Background: Mesoamerican nephropathy (MeN) is a distinct, non-diabetic form of chronic kidney disease (CKD) primarily affecting young agricultural workers in Central America. Unlike traditional CKD, MeN is characterized by tubulointerstitial damage, minimal proteinuria, and rapid progression to end-stage renal disease (ESRD) in the absence of hypertension or diabetes. While the proposed etiology is multifactorial (ncluding heat stress, recurrent dehydration, and environmental toxins), its hematologic implications remain poorly studied. Given the high global burden of CKD-associated anemia and the clinical impact of platelet dysfunction in ESRD, understanding whether MeN carries distinct risks for anemia, transfusion, and platelet abnormalities is critical for informing hematologic management in this unique population.

Objectives: To investigate predictors of anemia, platelet count, and transfusion requirement in patients with ESRD receiving hemodialysis, with subgroup analysis by CKD type (MeN vs. non-MeN), and to assess whether inflammation or nutritional status may contribute to hematologic outcomes.

Methods: This retrospective cross-sectional study analyzed clinical and laboratory data from 594 patients undergoing thrice-weekly hemodialysis in Nicaragua. CKD type was defined as MeN (n = 393) or classical CKD (n = 201) based on clinical adjudication. Data included age, sex, comorbidities, dialysis frequency, and laboratory parameters: complete blood count, serum creatinine, total urea, serum albumin, and inflammatory indices including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and eosinophil-to-lymphocyte ratio (ELR). Anemia was defined as hemoglobin <10 g/dL. Transfusion history and frequency were documented. Statistical analysis included Mann–Whitney U tests and multivariable logistic and linear regression models, stratified by CKD type.

Results: The overall prevalence of anemia was 47%, with no significant difference in mean hemoglobin between MeN and non-MeN groups (11.1 vs. 11.5 g/dL, p = 0.65). In the full cohort, lower serum albumin (OR = 0.22 per g/dL, 95% CI: 0.12–0.38, p < 0.0001), higher serum creatinine (OR = 1.26 per mg/dL, 95% CI: 1.10–1.45, p = 0.0005), and elevated PLR (OR = 1.07 per unit, 95% CI: 1.01–1.13, p = 0.021) were independently associated with anemia. These associations persisted when models were stratified by CKD type, although point estimates varied. Linear regression revealed that PLR was positively associated with platelet count (β = +11.9 platelets ×10⁹/L per PLR unit, p < 0.0001), while NLR was inversely associated (β = −41.6, p < 0.0001), suggesting divergent effects of lymphocyte-skewed versus neutrophil-skewed inflammation on megakaryopoiesis or platelet consumption. MLR and other metabolic parameters were not significant predictors.

Patients with MeN were significantly younger (mean 49.6 vs. 61.7 years, p < 0.0001) and had lower PLR (11.2 vs. 14.6, p = 0.049), although absolute platelet counts were similar between groups (254 vs. 257 ×10⁹/L, p = 0.98). ELR was modestly lower in MeN patients (0.189 vs. 0.200, p = 0.061), suggesting a potential immunologic difference not reaching statistical significance. Transfusion was required in 8.5% of patients. In multivariable logistic regression, transfusion risk was significantly higher in patients with MeN (OR = 4.57, 95% CI: 1.33–15.69, p = 0.015), independent of other clinical and laboratory factors. Additional predictors included low serum albumin (OR = 0.22, p = 0.0004) and high creatinine (OR = 1.17, p = 0.005). PLR and age were not independently associated with transfusion need in the adjusted model. These findings indicate a disproportionately high transfusion burden in MeN, even in the absence of more severe anemia or comorbid disease.

Conclusions: Among patients with ESRD on hemodialysis, anemia and transfusion needs are independently associated with low serum albumin, high creatinine, and inflammatory markers. While MeN patients exhibit similar hemoglobin and platelet counts compared to those with classical CKD, they have a markedly higher likelihood of transfusion, suggesting underlying differences in erythropoietic suppression, iron availability, or treatment responsiveness. Inflammatory indices such as PLR and NLR may serve as useful adjuncts for hematologic risk stratification in this population.

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2025
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