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New Emirates Medical Journal

Volume 3, 2 Issues, 2022
ISSN: 0250-6882 (Online)
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Open Access Article

Prevalence of ABO Blood Grouping among Hemodialysis Patients in Dubai

Fakhriya Alalawi1, *, Kashif Gulzar1, Waleed Mohamed Galaleldin1, Amna Alhadari1
1 Department of Nephrology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates



Beyond their vital role in blood transfusion, ABO antigens were speculated to be involved in developing various human illnesses, including infectious, neoplastic, cardiovascular, and many others. Many researchers attempted to highlight the relationship between kidney disease and ABO phenotypes. The majority of these reports showed a predominance of blood group O antigen among patients with chronic kidney disease, while few had opposed these findings. We aimed in this study to elaborate on blood group typing among our hemodialysis patients and whether it has a prognostic effect on the overall mortality.


This is an observational, cross-sectional, retrospective study among chronic adult hemodialysis patients being dialyzed at Dubai Hospital over the past six months, from Jan 2021 till June 2021. The patient's demographic characteristics (age, sex, etiology of chronic kidney disease, medical comorbidities, and blood groups) were retrieved using an electronic hospital medical record system.


Our study population constituted 224 hemodialysis patients; their mean age was 55.4 years (16-94 years), 83.6% were UAE nationals, and 59.8% were males. Diabetic nephropathy was the etiology of end-stage kidney disease in 46%. ABO blood group distribution among our study population was as follows; group O was the commonest (45%), followed by group B positive (23%) and A Positive (20.9%). Among the UAE national patients group, O+ constitutes 46.9%, followed by B+ in 24%, and A+ in 21%. Nevertheless, group O+ was still the commonest among the non-national hemodialysis patients in 37.7%, A+ in 28.8%, and B+ in 24.4%. Additionally, group O-positive was the predominant group among all diabetic dialysis patients (47%). Nine patients died during the study period of different causes; out of them, 4 patients (44.4%) had group O positive.


Blood group O was the commonest blood group among our hemodialysis patients. Additionally, it was the commonest group in all diabetic dialysis patients. More studies from Arab countries are needed to comprehend the relationship between ABO blood phenotypes and kidney disease and whether certain blood groups have any role in a patient's progression to ESKD.

Keywords: ABO group, HD: hemodialysis, ESKD: End-Stage Kidney Disease, Mortality, Blood group phenotype, Diabetic nephropathy.

Article Information

Identifiers and Pagination:

Year: 2022
Volume: 3
Issue: 2
E-location ID: e310522205460
Publisher Id: e310522205460
DOI: 10.2174/03666220531142340

Article History:

Received Date: 10/12/2021
Revision Received Date: 5/1/2022
Acceptance Date: 29/1/2022
Electronic publication date: 07/07/2022
Collection year: 2022

© 2022 Alalawi et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Nephrology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates; E-mail:


Worldwide, 2.6 million people are suffering from End-stage kidney disease (ESKD), which includes 11.5% population of UAE [1, 2]. Diabetes mellitus, hypertension, obesity, and glomerulonephritis are the commonest causes of ESKD in Dubai and the world [3, 4]. Historically, the ABO antigen system was widely used for blood transfusion and organ transplantation. Also, increasing evidence accumulated over the past few decades suggests that these antigens are implicated in developing many human illnesses, including infectious, neoplastic, cardiovascular, neurological diseases, and many others [5]. Furthermore, ABO blood group antigens have been accounted for inflammation and infections, primarily involved in developing and advancing immune-mediated diseases [6].

Similarly, many investigators tried to highlight the association between kidney diseases and ABO phenotypes. The majority of these reports showed a prevalence of blood group O antigen among patients with renal failure, while few had opposed these findings. Therefore, we aimed in this study to elaborate more on blood group typing among our hemodialysis patients and whether it has a significant prognostic effect on the overall mortality.


2.1. Study Design and Participants

This is a retrospective, cross-sectional, observational study among chronic adult hemodialysis patients being dialyzed in our center at Dubai Hospital over the past six months, from Jan 2021 till June 2021, including patients who died during this period. All adults patients on chronic hemodialysis irrespective of their age, gender, nationality, and duration of dialysis were enrolled. This study excluded less than 14 years old and renal transplant recipients.

2.2. Data Collection

Medical records of the study population were reviewed using electronic medical records (Epic Hyperspace; SALAMA) to retrieve patients' demographic characteristics (such as age, sex, etiology of chronic kidney disease (CKD), and other medical comorbidities), in addition to blood group data (Table 1).

2.3. Statistical Analysis

Continuous variables were defined as median and interquartile range (IQR) values, and categorical variables were presented as frequency and percentage. Independent t-test and Mann Whitney test were utilized for continuous variables, and categorical data were matched with the help of Pearson's chi-square test or Fischer's exact test. The relationship between mortality and blood group in hemodialysis patients was analyzed using Cox proportional hazard regression. A p-value of <0.05 was considered statistically significant. SPSS version-20 was used for statistical analysis.


Nine hemodialysis patients were excluded from the study because of the unavailability of the blood group in their records; thus, a total of 224 patients were included. Their median age was 56 years (16-94) old. Male patients were 59.82% (n=134) out of which 83.6% (n=179) were from U.A.E. The most common cause of end-stage kidney disease (ESKD) is diabetic nephropathy (n=104, 46.42%), followed by chronic glomerulonephritis (n= 67, 29.91%). Predominant comorbid were hypertension (148, 66.07%) and diabetes mellitus (131, 58.48%).

The distribution of the ABO group among hemodialysis populace was as follows (Table 2); group O positive were the commonest among our dialysis population, which consists of 101 patients (45.08%), followed by group B positive and A positive in 52 (23.21%), 47(20.9%) patients respectively, while 24 (11.62%) patients had less common blood groups {A-ve (n=4,1.8%), AB -ve (n=2, 0.9%), AB +v (n=15, 6.7%), and B -ve (n=3, 1.3%)}. In our study population, Blood group O positive remained the commonest among UAE nationals (46.9%) and expats (37.7%) as well, while A+ and B+ were the second most common blood group in expats (28%) and UAE (24%) nationals, respectively. Additionally, O-positive blood group was the predominant among male (n=62, 46.26%), diabetics (n=66, 50.38%), and hypertensive patients (n=64,43.24%). Total nine (4.01%) hemodialysis patients expired during the study period. The mortality rate was 3.96% (n=4, consisting of 44.4% of the total mortality) among O-positive hemodialysis patients and 4.25% (n=2) and 3.84% (n=2) in A+ and B+, respectively (Fig. 1).

Fig. (1)
ABO group distribution among hemodialysis patients.

Table 1
Baseline hemodialysis patient’s characteristics (n=224).

Table 2
Group distribution according to nationality, gender, co-morbid and mortality rate.


ABO phenotype is crucial for blood transfusion and organ transplant compatibility since it was first described by the Austrian Nobel Prize Karl Landsteiner in 1900 [7]. The ABO grouping system is composed of 3-main alleles, two co-dominants A and B and one recessive O, and is organized by a solitary gene positioned on the terminal part of the long arm of chromosome-9 [8]. The blood groups antigens are glycolipids and glycoproteins expressed on the surface of red blood cells and other tissues, including platelets, the epithelium, vascular endothelium, and sensory neurons [9]. Blood group O-positive is the most popular blood group globally; 37.37% of the world population carry this blood group. Its prevalence is up to 100% observed in Peru. In the Arab world, its prevalence in Egypt, Saudi Arabia, and UAE is 52%, 48%, and 44%, respectively, while the least prevalence is reported in Hungry, 27% [10, 11].

ABO antigens might be involved in the progress of many human disorders, including infectious, neoplastic, cardiovascular, and neurological illnesses, though agreement about this association is not accepted universally [5]. Subjects with blood group-A were noticed to have an elevated risk for H. pylori infection, gastric cancers, and chronic atrophic gastritis and experienced more refractory iron deficiency anemia than other blood phenotypes [12, 13]. On the other hand, individuals with blood group-O have a greater risk for peptic ulcers and raised inflammatory reactions to H. pylori [14, 15]. Expanding proof hypothesize that those blood group antigens may fill in as receptors for bacteria, parasites, and different viruses [6, 16]. It is possible to influence host-pathogen interactions at various levels of glycosylation since infectious organisms frequently use cell surface glycosylated receptors for their connection, although exact mechanisms triggering these immune-mediated diseases are not yet known [17]. Such association is believed to exist between P. falciparum malaria and people with blood group O, where group O individuals will, in general, have favorable outcomes and better survival for P. falciparum malaria compared to group A subjects [18, 19]. This was further validated in subsequent studies [20, 21]. Similarly, Ray et al. reported a low risk of severe COVID-19 disease and related mortality in individuals carrying type O blood group versus other blood groupings in 225,556 Canadian patients [22]. In contrast, Coluk et al. reported an equal risk of COVID-19 disease among all blood group phenotypes; however, his sample included 211 patients [23]. On the contrary, patients with group O confer a greater possibility of severe infection and complications from Vibrio cholera than non-O-blood group carriers [24]. One more field that has been comprehensively studied over the past decades is the association between the ABO blood grouping and malignancies, with the steadiest association being seen between participants holding blood group A, AB, or B and the high incidences of pancreatic and gastric cancers, compared with blood group O subjects [25-27]. Molecular dynamics-based methods are being used to understand the complex interaction of carbohydrates and protein within ABO antigens since these interactions might be important in defining an association between ABO phenotypes and other diseases [28]. Rajshri and colleagues investigated the conformational preferences of Lewis Y oligosaccharide blood group antigen and determined the molecular basis of its interaction with cholera toxin, which may help develop a potent cholera toxin inhibitor or vaccine to fight one of the oldest diseases [28]. Further studies had covered different additional areas of ABO phenotypes. Individuals with non-O blood phenotype carry an approximately twofold higher risk of venous thromboembolism (VTE) [29] and arterial thrombosis and trigger a high risk for myocardial infarction and cerebrovascular accidents, in a latest systematic review of 28 analysis enrolling 12,231 individuals admitted with ischemic stroke or myocardial infarction [30]. Additionally, in a retrospective case-control publication, the O blood group population has a 10% less risk of developing coronary artery disease [31]. Also, it protects atrial fibrillation patients from developing peripheral arterial thrombosis [32]. Similarly, there is an increased risk to acquire nonalcoholic fatty liver disease among non-O blood antigens than blood group O antigen carrying population [33]. In regards to kidney diseases, few studies highlighted such association. Hamed et al. in 1979, probably was the first to conduct a study to compare the ABO blood phenotype distribution among 184 patients with parenchymal kidney disease, confirmed by renal biopsy and 3,820 normal populations [34]. The appropriation of renal patients corresponding to the blood groups was considerably unique from the distribution of the ordinary subjects. The dissimilarity happened primarily in the B and O blood groups, showing a 7 percent increase in group B and a 10% decline in group-O in renal patients [34]. We observed a prevalence of blood group O positive in 45.08% and B positive in 23.21% of dialysis patients. Alanan U and Hasson et al. also reported O positive to be the most predominant group in their dialysis population, in 51.1% and 55%, respectively [35, 36]. Whereas Alhawary et al. found a prevalence of group A (45.7%), followed by group O (30.4%) in patients with renal failure. Additionally, he studied different variables in relation to ABO groups (HCT, MCV, Ferritin, BUN, Creatinine, phosphorous, calcium, albumin, and Sodium), and the association between all variables and blood groups of patients with renal failure were not statistically significant, except for potassium level, which was statistically high in patients with blood group A [37]. A recent analysis by Yang et al. in 2017, for patients with advanced IgAN, reported those with blood type O or A (non-B antigen group) to have a fast decline in kidney functions, compared to patients with type B/ or AB, and the relationship is independent to sex, age, systolic blood pressure (SBP), baseline eGFR or other variables. Furthermore, they had a higher systolic BP, lactate dehydrogenase, uric acid, higher C-reactive protein, and tumor necrosis factor-α than patients with type B/AB blood groups. Additionally, the non-B group was independently associated with increased risk for ESKD [6].

Table 3
Comparison of variables between dead and alive hemodialysis patients.

Whether our data reflects group O dominance in the UAE population, rather being a real dominance related to kidney diseases is possible, yet our dialysis center has different nationalities with different predominant blood groups in their countries. Nevertheless, in non-national hemodialysis patients, blood group O positive was still the commonest in 37.7%, followed by A+ 28.8%, then B+ 24.4%. Moreover, among our UAE national hemodialysis patients, group B+ is the second dominant group in 24%, followed by A+ in 21%, which is different from ABO distribution in the UAE general population, pointing out that certain blood groups have a particular affinity for dialysis patients. On the other hand, diabetic patients had a predominance of group O-positive in 47% of the cases, followed by group B-positive in 23% and group A-positive in 17%. In contrast, Bener et al. found B positive significantly more common among diabetics than the general population (25.7% vs. 20.4%, p= 0.01) [38]. Whether blood group O positive can lead to a worse prognosis for kidney disease in diabetic patients or not, this needs to be validated in further studies. Nine patients died during the study period of different causes. The mortality rate was only 1.78% (p=0.298, Table 3) among the total dialysis patients with O-positive and 33% (1 out of 3 patients) in B negative dialysis patients; however, this was not statistically significant, and the sample size was less. In a large Canadian study in 1989, including 8,432 patients with ESKD, those with group AB were noted to have a low risk of death compared to other blood groups, although it was not statistically significant. Authors clarified this finding that patients with phenotype AB easily get a transplant than other blood groups [39].


Group O was the commonest blood group among our hemodialysis population. In addition, it was the commonest group among national and non-national patients and the commonest in all diabetic dialysis patients. However, these results remained crude, and more studies from Arab countries are necessary to comprehend the relationship between ABO blood phenotypes and kidney disease and if certain blood groups have any role in the patient's progression toward ESKD.


The study was approved by the Dubai Scientific Research Ethics Committee of Dubai Health Authority, approval number DSREC-08/2021_13.


Not applicable.


Informed consent was waived.


STROBE guidelines and methodologies were followed in this study.


The data supporting the findings of this study are available within the article.




All authors declare no conflict of interest, financial or otherwise


Declared none.


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Abdullah Shehab
Emirates Cardiac Society
Emirates Medical Association
(United Arab Emirates)
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