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Multicenter Study
. 2013 Jan 7:14:2.
doi: 10.1186/1471-2369-14-2.

The development of anemia is associated to poor prognosis in NKF/KDOQI stage 3 chronic kidney disease

José Portolés  1 , Jose Luis Gorriz, Esther Rubio, Fernando de Alvaro, Florencio García, Vicente Alvarez-Chivas, Pedro Aranda, Alberto Martinez-Castelao; NADIR-3 Study Group
Collaborators, Affiliations
Multicenter Study

The development of anemia is associated to poor prognosis in NKF/KDOQI stage 3 chronic kidney disease

José Portolés et al. BMC Nephrol. .

Abstract

Background: Anemia is a common condition in CKD that has been identified as a cardiovascular (CV) risk factor in end-stage renal disease, constituting a predictor of low survival. The aim of this study was to define the onset of anemia of renal origin and its association with the evolution of kidney disease and clinical outcomes in stage 3 CKD (CKD-3).

Methods: This epidemiological, prospective, multicenter, 3-year study included 439 CKD-3 patients. The origin of nephropathy and comorbidity (Charlson score: 3.2) were recorded. The clinical characteristics of patients that developed anemia according to EBPG guidelines were compared with those that did not, followed by multivariate logistic regression, Kaplan-Meier curves and ROC curves to investigate factors associated with the development of renal anemia.

Results: During the 36-month follow-up period, 50% reached CKD-4 or 5, and approximately 35% were diagnosed with anemia (85% of renal origin). The probability of developing renal anemia was 0.12, 0.20 and 0.25 at 1, 2 and 3 years, respectively. Patients that developed anemia were mainly men (72% anemic vs. 69% non-anemic). The mean age was 68 vs. 65.5 years and baseline proteinuria was 0.94 vs. 0.62 g/24h (anemic vs. non anemic, respectively). Baseline MDRD values were 36 vs. 40 mL/min and albumin 4.1 vs. 4.3 g/dL; reduction in MDRD was greater in those that developed anemia (6.8 vs. 1.6 mL/min/1.73 m2/3 years). These patients progressed earlier to CKD-4 or 5 (18 vs. 28 months), with a higher proportion of hospitalizations (31 vs. 16%), major CV events (16 vs. 7%), and higher mortality (10 vs. 6.6%) than those without anemia. Multivariate logistic regression indicated a significant association between baseline hemoglobin (OR=0.35; 95% CI: 0.24-0.28), glomerular filtration rate (OR=0.96; 95% CI: 0.93-0.99), female (OR=0.19; 95% CI: 0.10-0.40) and the development of renal anemia.

Conclusions: Renal anemia is associated with a more rapid evolution to CKD-4, and a higher risk of CV events and hospitalization in non-dialysis-dependent CKD patients. This suggests that special attention should be paid to anemic CKD-3 patients.

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Figures

Figure 1
Figure 1
Flowchart of subjects included in the study.
Figure 2
Figure 2
Survival distribution function according to: A. Time to development of anemia (competing risk model with death and RRT). B. Evolution to CKD-4 or CKD-5 for all the CKD-3 patients included in the study (Kaplan-Meyer). C. Evolution to CKD-4 or -5 for patients that developed renal anemia (Yes) and the non-anemic patients (No) (Kaplan-Meyer). See text for details.
Figure 3
Figure 3
Receiver operator characteristic (ROC) curve showing the sensitivity and specificity of the model incorporating eGFR, HB and gender to predict development of anaemia within the 3-year follow-up period.
See this image and copyright information in PMC

References

    1. Whaley-Connell A, Sowers JR, McCullough PA, Roberts T, McFarlane SI, Chen SC, Li S, Wang C, Collins AJ, Bakris GL. Diabetes mellitus and CKD awareness: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) Am J Kidney Dis. 2009;53(4 Suppl 4):S11–S21. - PubMed
    1. Coresh J, Astor B, Sarnak MJ. Evidence for increased cardiovascular disease risk in patients with chronic kidney disease. Curr Opin Nephrol Hypertens. 2004;13(1):73–81. doi: 10.1097/00041552-200401000-00011. - DOI - PubMed
    1. Otero A, de Francisco A, Gayoso P, Garcia F. Prevalence of chronic renal disease in Spain: results of the EPIRCE study. Nefrologia. 2010;30(1):78–86. - PubMed
    1. ERA/EDTA. Revised European Best Practice Guidelines for the Management of Anaemia in Patients with Chronic Renal Failure. Anaemia evaluation. Nephrol Dial Transplant. 2004;19(Suppl. 2):ii2–ii5. - PubMed
    1. Stancu S, Barsan L, Stanciu A, Mircescu G. Can the response to iron therapy be predicted in anemic nondialysis patients with chronic kidney disease? Clin J Am Soc Nephrol. 2010;5(3):409–416. doi: 10.2215/CJN.04280609. - DOI - PMC - PubMed

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