Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun:200:110695.
doi: 10.1016/j.diabres.2023.110695. Epub 2023 May 6.

Prevalence of anemia and associated All-Cause mortality among adults with Diabetes: The role of chronic kidney disease

Alain K Koyama  1 , Elizabeth Lundeen  2 , Kai McKeever Bullard  3 , Meda E Pavkov  4
Affiliations

Prevalence of anemia and associated All-Cause mortality among adults with Diabetes: The role of chronic kidney disease

Alain K Koyama et al. Diabetes Res Clin Pract. 2023 Jun.

Abstract

Aims: Among adults with diabetes in the United States, we evaluated anemia prevalence by CKD status as well as the role of CKD and anemia, as potential risk factors for all-cause mortality.

Methods: In a retrospective cohort study, we included 6,718 adult participants with prevalent diabetes from the 2003-March 2020 National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the non-institutionalized civilian population in the United States. Cox regression models evaluated the role of anemia and CKD, alone or combined, as predictors of all-cause mortality.

Results: Anemia prevalence among adults with diabetes and CKD was 20%. Having anemia or CKD alone, compared with having neither condition, was significantly associated with all-cause mortality (anemia: HR = 2.10 [1.49-2.96], CKD: HR = 2.24 [1.90-2.64]). Having both conditions conferred a greater potential risk (HR = 3.41 [2.75-4.23]).

Conclusions: Approximately one-quarter of the adult US population with diabetes and CKD also has anemia. The presence of anemia, with or without CKD, is associated with a two- to threefold increased risk of death by compared with adults who have neither condition, suggesting that anemia may be a strong predictor of death among adults with diabetes.

Keywords: Anemia; CKD; Diabetes; Kidney disease; Mortality.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1 -
Figure 1 -. Age-adjusted prevalence of anemia among adults with diabetes by CKD status, National Health and Nutrition Examination Survey (NHANES) 2003-March 2020.
The top figure shows percentages and corresponding 95% confidence intervals. Prevalence is adjusted to age distributions from 2000 United States Census Bureau data. The bottom figure shows weighted counts based on U.S. population totals for NHANES 2017-March 2020. Variance estimates account for the complex survey design. Abbreviations: CKD = chronic kidney disease.
Figure 2 -
Figure 2 -. Adjusted hazard ratios for all-cause mortality by the presence of anemia and CKD in participants with diabetes, National Health and Nutrition Examination Survey 2003–2018 (n=6,193).
Variance estimates account for the complex survey design. Age is adjusted for as the time scale in all models. Model 1 is adjusted for sex and race/ethnicity. Model 2 is further adjusted for education, smoking status, body mass index, hemoglobin A1c, total cholesterol. Abbreviations: CKD = chronic kidney disease.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention. National Diabetes Statistics Report. Atlanta, GA.
    1. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018;41:917–28. 10.2337/dci18-0007 - DOI - PMC - PubMed
    1. Gauci R, Hunter M, Bruce DG, Davis WA, Davis TME. Anemia complicating type 2 diabetes: Prevalence, risk factors and prognosis. J Diabetes Complications. 2017;31:1169–74. 10.1016/j.jdiacomp.2017.04.002 - DOI - PubMed
    1. Vlagopoulos PT, Tighiouart H, Weiner DE, Griffith J, Pettitt D, Salem DN, et al. Anemia as a risk factor for cardiovascular disease and all-cause mortality in diabetes: the impact of chronic kidney disease. J Am Soc Nephrol. 2005;16:3403–10. 10.1681/ASN.2005030226 - DOI - PubMed
    1. AlDallal SM, Jena N. Prevalence of Anemia in Type 2 Diabetic Patients. J Hematol. 2018;7:57–61. 10.14740/jh411w - DOI - PMC - PubMed

LinkOut - more resources