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. 2022 Jan 12;15(6):1120-1128.
doi: 10.1093/ckj/sfac004. eCollection 2022 Jun.

New-onset anemia and associated risk of ESKD and death in non-dialysis CKD patients: a multicohort observational study

Roberto Minutolo  1 , Michele Provenzano  2 , Paolo Chiodini  3 , Silvio Borrelli  1 , Carlo Garofalo  1 , Michele Andreucci  2 , Maria Elena Liberti  1 , Vincenzo Bellizzi  4 , Giuseppe Conte  1 , Luca De Nicola  1 ; Collaborative Study Group on the Conservative Treatment of CKD of the Italian Society of Nephrology
Collaborators, Affiliations

New-onset anemia and associated risk of ESKD and death in non-dialysis CKD patients: a multicohort observational study

Roberto Minutolo et al. Clin Kidney J. .

Abstract

Background: Anemia is a common complication of chronic kidney disease (CKD), but its incidence in nephrology settings is poorly investigated. Similarly, the risks of adverse outcomes associated with new-onset anemia are not known.

Methods: We performed a pooled analysis of three observational cohort studies including 1031 non-anemic CKD patients with eGFR <60 mL/min/1.73 m2 regularly followed in renal clinics. We estimated the incidence of mild anemia (hemoglobin 11-12 g/dL in women and 11-13 g/dL in men) and severe anemia (hemoglobin <11 g/dL or use of erythropoiesis-stimulating agents) during a 3-year follow-up period. Thereafter we estimated the risk of end-stage kidney disease (ESKD) and all-cause death associated with new-onset mild and severe anemia.

Results: The mean age was 63 ± 14 years, 60% were men and 20% had diabetes. The mean estimated glomerular filtration rate (eGFR) was 37 ± 13 mL/min/1.73 m2 and the median proteinuria was 0.4 g/day [interquartile range (IQR) 0.1-1.1]. The incidence of mild and severe anemia was 13.7/100 patients-year and 6.2/100 patients-year, respectively. Basal predictors of either mild or severe anemia were diabetes, lower hemoglobin, higher serum phosphate, eGFR <30 mL/min/1.73 m2 and proteinuria >0.50 g/day. Male sex, moderate CKD (eGFR 30-44 mL/min/1.73 m2) and moderate proteinuria (0.15-0.50 g/day) predicted only mild anemia. The incidence of anemia increased progressively with CKD stages (from 8.77 to 76.59/100 patients-year) and the proteinuria category (from 13.99 to 25.02/100 patients-year). During a median follow-up of 3.1 years, 232 patients reached ESKD and 135 died. Compared with non-anemic patients, mild anemia was associated with a higher adjusted risk of ESKD {hazard ratio [HR] 1.42 [95% confidence interval (CI) 1.02-1.98]} and all-cause death [HR 1.55 (95% CI 1.04-2.32)]. Severe anemia was associated with an even higher risk of ESKD [HR 1.73 (95% CI 1.20-2.51)] and death [HR 1.83 (95% CI 1.05-3.19)].

Conclusions: New-onset anemia is frequent, particularly in patients with more severe renal damage and in those with diabetes mellitus. The occurrence of anemia, even of a mild degree, is associated with mortality risk and faster progression towards ESKD.

Keywords: ESKD; anemia; epidemiology; non-dialysis CKD.

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Figures

Graphical Abstract
Graphical Abstract
FIGURE 1:
FIGURE 1:
Cumulative incidence of severe anemia by (A) CKD stage or (C) proteinuria category and of mild anemia by (B) CKD stage or (D) proteinuria category.
See this image and copyright information in PMC

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