Clinical impact of hospital-acquired anemia in association with acute kidney injury and chronic kidney disease in patients with acute myocardial infarction

Abstract

Background: Hospital-acquired anemia (HAA) is common in patients with acute myocardial infarction (AMI) and is an independent indicator of long-term mortality in these patients. However, limited information exists regarding the development and prognostic impact of HAA associated with acute kidney injury (AKI) and chronic kidney disease (CKD) in AMI patients.

Methods and results: We retrospectively analyzed 2,289 patients with AMI, and excluded those with anemia at admission. The study population included 1,368 patients, of whom 800 (58.5%) developed HAA. Age, Hgb level at admission, Length of hospital stay, documented in-hospital bleeding and use of glycoprotein IIb/IIIa inhibitor, presence of CKD and occurrence of AKI were significantly associated with the development of HAA. HAA was significantly associated with higher 3-year mortality (4.8% and 11.4% for non-HAA and HAA patients, respectively; P < 0.001). After adjustment for multivariable confounders, the risk for long-term mortality was increased in HAA patients with AKI and/or CKD but not in HAA patients without AKI and/or CKD, compared to non-HAA patients (HAA patients without AKI and CKD, hazard ratio [HR]: 1.34, 95% confidence interval [CI]: 0.70-2.56; HAA patients with either AKI or CKD, HR: 2.80, 95% CI: 1.37-5.73; HAA patients with AKI and CKD, HR: 3.25, 95% CI: 1.28-8.24; compared with the non-HAA group).

Conclusion: AKI and CKD were strongly associated with the development of HAA in AMI patients. HAA, when accompanied by AKI or CKD, is an independent risk predictor for long-term mortality in AMI patients.

Figure 1. The 3-year cumulative survival rate of HAA patients with or without AKI and CKD.

group I= non-HAA patients; group II= HAA patients without AKI and CKD; group III= HAA patients either AKI or CKD; group IV= HAA patients with both AKI and CKD.