Can CBC Profile and Liver Function Test Predict Chronic Kidney Disease among a Normal Population?

Mahmood Moosazadeh, Fatemeh Espahbodi, Mahdi Afshari, Arman Eslami


Background: Kidney disorders are mainly diagnosed after a major decline in the renal function. Chronic kidney disease (CKD) is one of the most common disorders of the urinary system defined by gradual reduction of renal function. Considering the silent nature and late diagnosis of this problem, this study aims to investigate the prevalence of CKD and its association with Complete Blood Count (CBC) profile and liver function tests.

Methods: Out of the total population enrolled in the Tabari cohort study, 5822 subjects without history of diabetes mellitus, hypertension, cardiac disease, renal failure, cancer, and pathologic obesity were selected. Glomerular filtration rate (GFR) was calculated using creatinine clearance as well as Modification of Diet in Renal Disease (MDRD) equation. CKD was defined as GFR decline less than 60 ml/min/1.73 m2 regardless of its main cause.

Results: Prevalence of CKD in total population as well as men and women was 20.2%, 16.8%, and 23.1%, respectively. Multivariate models showed the odds ratios for third and fourth quartiles of Mean corpuscular volume (MCV) and also for the fourth quartile of the lymphocyte count as of 0.78 (0.64, 0.95), 0.81 (0.67, 0.99), and 1.22 (1.01, 1.47), respectively. Corresponding odds ratios for the fourth, third, and second quartiles of Blood Urea Nitrogen (BUN) were 1.42 (1.14, 1.77), 1.76 (1.42, 2.19), and 2.79 (2.27, 3.43), respectively.

Conclusions: This study showed a high prevalence of CKD among the normal residents (without major underlying diseases and excessive obesity) in the north of Iran, especially among women. In addition, low MCV, low lymphocyte, and high BUN were detected as predictors of this disorder


Blood cell count; chronic; cohort studies; liver function tests; renal Insufficiency

Full Text:



Chen TK, Knicely DH, Grams ME. Chronic kidney disease

diagnosis and management: A review. JAMA 2019;322:1294‑304.

Sharifian M, Jabbarpour J. Prevalence of chronic kidney disease

complication in children admitted Mofid hospital in 2014–2015.

Res Med 2016;39;208‑12.

George C, Matsha TE, Erasmus RT, Kengne AP. Haematological

profile of chronic kidney disease in a mixed‑ancestry South African

population: A cross‑sectional study. BMJ Open 2018;8:e025694.

Wang B, Lu H, Gong Y, Ying B, Cheng B. The association

between red blood cell distribution width and mortality in

critically ill patients with acute kidney injury. Biomed Res Int


Hill NR, Fatoba ST, Oke JL, Hirst JA, O’Callaghan CA,

Lasserson DS, et al. Global prevalence of chronic kidney

disease‑A systematic review and meta‑analysis. PLoS One


Pizzorno J. The kidney dysfunction epidemic, Part 1: Causes.

Integr Med (Encinitas) 2015;14:8‑13.

Luyckx VA, Tonelli M, Stanifer JW. The global burden of kidney

disease and the sustainable development goals. Bull World

Health Organ 2018;96:414‑22D.

Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney

disease. Lancet 2017;389:1238‑52.

Zhang M, Zhang Y, Li C, He L. Association between red blood

cell distribution and renal function in patients with untreated

type 2 diabetes mellitus. Ren Fail 2015;37:659‑63.

Lu YA, Fan PC, Lee CC, Wu VC, Tian YC, Yang CW, et al. Red

cell distribution width associated with adverse cardiovascular

outcomes in patients with chronic kidney disease. BMC Nephrol


Hadian B, Anbari K, Heidari R. Epidemiologic study of end

stage renal disease and related risk factors in patients under

hemodialysis in Lorestan province. yafte 2015;16:44‑53.

Sette LH, Almeida Lopes EP. Liver enzymes serum levels

in patients with chronic kidney disease on hemodialysis:

A comprehensive review. Clinics (Sao Paulo) 2014;69:271‑8.

Sette LH, Lopes EP. The reduction of serum aminotransferase

levels is proportional to the decline of the glomerular filtration

rate in patients with chronic kidney disease. Clinics (Sao Paulo)


Kheradmand M, Moosazadeh M, Saeedi M, Poustchi H,

Eghtesad S, Esmaeili R, et al. Tabari cohort profile and

preliminary results in urban areas and mountainous regions of

Mazandaran, Iran. Arch Iran Med 2019;22:279‑85.

Poustchi H, Eghtesad S, Kamangar F, Etemadi A, Keshtkar AA,

Hekmatdoost A, et al. Prospective epidemiological research

studies in Iran (The PERSIAN cohort study): Rationale,

objectives, and design. Am J Epidemiol 2018;187:647‑55.

Eghtesad S, Mohammadi Z, Shayanrad A, Faramarzi E, Joukar F,

Hamzeh B, et al. The PERSIAN cohort: Providing the evidence

needed for healthcare reform. Arch Iran Med 2017;20:691‑5.

National Kidney Foundation. K/DOQI clinical practice

guidelines for chronic kidney disease: Evaluation, classification,

and stratification. Am J Kidney Dis 2002;39 (2 Suppl 1):S1‑266.

Vassalotti JA, Stevens LA, Levey AS. Testing for chronic

kidney disease: A position statement from the National Kidney

Foundation. Am J Kidney Dis 2007;50:169‑80.

Sun IO, Chung BH, Yoon HJ, Kim JH, Choi BS, Park CW, et al.

Clinical significance of red blood cell distribution width in the

prediction of mortality in patients on peritoneal dialysis. Kidney

Res Clin Pract 2016;35:114‑8.

Yonemoto S, Hamano T, Fujii N, Shimada K, Yamaguchi S,

Matsumoto A, et al. Red cell distribution width and renal

outcome in patients with non‑dialysis‑dependent chronic kidney

disease. PLoS One 2018;13:e0198825.

Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G,

Guidi GC. Relationship between red blood cell distribution width

and kidney function tests in a large cohort of unselected

outpatients. Scand J Clin Lab Invest. 2008;68:745-8.

Kim CH, Park JT, Kim EJ, Han JH, Han JS, Choi JY, et al.

An increase in red blood cell distribution width from baseline

predicts mortality in patients with severe sepsis or septic shock.

Crit Care 2013;17:R282.

Ani C, Ovbiagele B. Elevated red blood cell distribution width

predicts mortality in persons with known stroke. J Neurol Sci


Oh HJ, Park JT, Kim JK, Yoo DE, Kim SJ, Han SH. Red blood

cell distribution width is an independent predictor of mortality

in acute kidney injury patients treated with continuous renal

replacement therapy. Nephrol Dial Transplant 2012;27:589‑94.

Dyab Allawi AA. Yousif Mahmood M, Adnan Hammied F.

Correlation between liver enzymes and chronic kidney disease

Iraqi patients with or without hemodialysis. IOSR‑JDMS