The development of anemia is associated to poor prognosis in NKF/KDOQI stage 3 chronic kidney disease
Entity
UAM. Departamento de MedicinaPublisher
BioMed CentralDate
2013-01-09Citation
10.1186/1471-2369-14-2
BMC Nephrology 14 (2013): 2
ISSN
1471-2369DOI
10.1186/1471-2369-14-2Funded by
This study was partially supported by a grant from Amgen S.A., Barcelona, Spain, through the Spanish Society of Nephrology.Editor's Version
http://dx.doi.org/10.1186/1471-2369-14-2Subjects
Anemia; Cardiovascular risk; Chronic kidney disease; Epidemiology; Non-dialysis CKD patients; MedicinaRights
© 2013 Portoles et al.; licensee BioMed Central Ltd.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
Files in this item
Google Scholar:Portolés Pérez, José María
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Górriz, José Luis
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Rubio, Esther Diaz
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De Álvaro, Fernando
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García Álvarez, Florencio J.
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Alvarez-Chivas, Vicente
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Aranda Horcajo, Pedro
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Martínez-Castelao, Alberto M.
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