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Observational Study
. 2015 Jan 5;4(1):e001480.
doi: 10.1161/JAHA.114.001480.

Association of fluid retention with anemia and clinical outcomes among patients with chronic kidney disease

Szu-Chun Hung  1 , Ko-Lin Kuo  1 , Ching-Hsiu Peng  1 , Che-Hsiung Wu  1 , Yi-Chun Wang  1 , Der-Cherng Tarng  2
Affiliations
Observational Study

Association of fluid retention with anemia and clinical outcomes among patients with chronic kidney disease

Szu-Chun Hung et al. J Am Heart Assoc. .

Abstract

Background: Observational studies have demonstrated an association between anemia and adverse outcomes in patients with chronic kidney disease (CKD). However, randomized trials failed to identify a benefit of higher hemoglobin concentrations, suggesting that the anemia-outcome association may be confounded by unknown factors.

Methods and results: We evaluated the influence of fluid status on hemoglobin concentrations and the cardiovascular and renal outcomes in a prospective cohort of 326 patients with stage 3 to 5 CKD. Fluid status, as defined by overhydration (OH) level measured with bioimpedance, was negatively correlated with hemoglobin concentrations at baseline (r=-0.438, P<0.001). In multivariate regression analysis, OH remained an independent predictor of hemoglobin, second only to estimated glomerular filtration rate. Patients were stratified into 3 groups: no anemia (n=105), true anemia (n=82), and anemia with excess OH (n=139) (relative OH level ≥7%, the 90th percentile for the healthy population). During a median follow-up of 2.2 years, there was no difference in cardiovascular and renal risks between patients with true anemia and those with no anemia in the adjusted Cox proportional hazards models. However, patients with anemia with excess OH had a significantly increased risk of cardiovascular morbidity and mortality and CKD progression relative to those with true anemia and those with no anemia, respectively.

Conclusions: Fluid retention is associated with the severity of anemia and adverse cardiovascular and renal outcomes in patients with CKD. Further research is warranted to clarify whether the correction of fluid retention, instead of increasing erythropoiesis, would improve outcomes of CKD-associated anemia.

Keywords: anemia; bioimpedance; cardiovascular; kidney; overhydration.

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Figures

Figure 1.
Figure 1.
A low hemoglobin concentration may result from reduced red blood cell volume (true anemia) and/or from an increased extracellular water volume (hemodilution). CKD indicates chronic kidney disease; EPO, erythropoietin; GFR, glomerular filtration rate; RAAS, renin–angiotensin–aldosterone system; RBC, red blood cell.
Figure 2.
Figure 2.
Fluid status, as defined by relative overhydration (OH), was negatively correlated with hemoglobin concentrations (r=−0.438, P<0.001).
See this image and copyright information in PMC

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