Anaemia in the patient with renal insufficiency: documenting the impact and reviewing treatment strategies

Levin, Adam

doi:10.1093/ndt/14.2.292

Cited by 18 publications

(9 citation statements)

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“…Baseline information on relevant clinical variables previously found to be associated with mortality risk in this population (Levin, 1999; Rahman & Smith, 1998) was ascertained from the patients’ medical record. These included presence of diabetes and cardiovascular disease, as well as blood pressure, albumin, potassium, creatinine, hemoglobin, and blood urea nitrogen levels.…”

Section: Methodsmentioning

confidence: 99%

Association between depressive symptoms and mortality risk in chronic kidney disease.

et al. 2010

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Objective-Previous examinations of depression as a predictor of mortality in end-stage renal disease have yielded inconsistent findings. We sought to clarify the possible link with mortality by assessing depression at an earlier stage of renal impairment before the uremic disease state and depressive symptoms become highly confounded, and then following patients during the period of disease progression.Design-Prospective design using an assessment of depression prior to initiation of renal replacement therapy to predict mortality status an average of 81 months later in patients in the early stages of chronic kidney disease. Main Outcome Measures-Mortality status.Results-After controlling for relevant mortality risk factors (i.e., age, gender, presence of diabetes and cardiovascular disease, and potassium level), results of Cox regression analyses indicated that higher levels of nonsomatic depression symptoms were predictive of an increased mortality risk, χ 2 (1, N=359) = 8.02, p = .005. Patients with nonsomatic depression scores one standard deviation above the mean had an estimated mortality rate 21.4% higher than average scorers in this sample.Conclusion-Clinical implications of these findings point to the importance of assessment and treatment of depressive symptoms in patients with chronic kidney disease. Keywords chronic kidney disease; depression; mortalityChronic kidney disease (CKD) affects approximately 31 million people in the United States, at varying stages of severity (U. S. Renal Data System, 2008). CKD is associated with significant morbidity and mortality and, in many cases, eventually progresses to "end-stage"Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/ pubs/journals/HEA NIH Public Access renal failure requiring renal replacement intervention (i.e., renal dialysis or transplantation) to sustain life. Given that CKD typically develops as a complication secondary to diabetes or hypertension, poor control of blood glucose and blood pressure are significant predictors of morbidity in this population and often accelerate the progression of renal failure to end-stage disease (National Kidney Foundation, 2002). Cardiovascular events are also highly correlated with mortality in CKD (Anderson et al., 2009;U.S. Renal Data System, 2008). In addition, nutritional factors, as measured by low levels of serum albumin (Menon et al., 2005), increases in serum phosphate (Kestenbaum et al., 2004), and potassium levels (National Kidney Foundation, 2002), have been found to predict higher risk of all-cause mortality i...

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Section: Methodsmentioning

confidence: 99%

Association between depressive symptoms and mortality risk in chronic kidney disease.

et al. 2010

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“…Small studies of adult chronic renal insufficiency (CRI) have observed that patients are not routinely identified early in their clinical courses and are not treated with adequate attention to dietary protein, anemia, hypertension, and other co-morbid events [1,2,3,4,5,6,7,8]. Recently Nissenson et al [9] reviewed a large HMO database to identify an adult population with chronic kidney disease.…”

Section: Introductionmentioning

confidence: 99%

Chronic renal insufficiency in children: The 2001 Annual Report of the NAPRTCS

Seikaly

Emmett

et al. 2003

Pediatric Nephrology

194

119

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End-stage renal disease (ESRD) is a major cause of morbidity in children. Besides its high cost to society, ESRD carries significant mortality. Chronic renal insufficiency (CRI) often precedes ESRD. Identifying factors that correlate with the rate of progression to ESRD is beneficial in the management of children with CRI. Since 1994 the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) has extended its registry to include children with CRI, defined as creatinine clearance (C Cr ) <75 ml/min per 1.73 m 2 . As of January 2001, our database registered 4,666 children (<20 years of age) with CRI. Data analysis showed that at least 40% of patients entered had congenital urological anomalies; 39% of patients were followed for at least 3 years. Follow-up data showed that 31% of all registered patients progressed to ESRD by the end of the reporting period. There was a correlation between CRI and several co-morbid clinical factors: low hematocrit, hypoalbuminemia, hypocalcemia, hyperphosphatemia, and hyperparathyroidism, and the rate of progression to ESRD. Primary clinical diagnosis and the age at entry into registry were additional factors that correlated with the rate of progression to ESRD. The main cause of hospitalization in this registry was infection, which accounted for 45% of hospital admissions. Growth delay measured by standard deviation score at baseline was -1.40 at the time of registration. Our data suggest potential areas of improved care that could impact the onset of ESRD.Keywords Chronic renal failure · Etiology · Treatment A. Tejani is deceased.

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“…Even though the kidney senses this “mild degree of anemia” with increased erythropoietin production, this Hb of 13 g/dl is frequently “missensed” by health care professionals as “insignificant.” Anemia in patients with kidney disease is probably best defined using age‐ and sex‐matched normal levels of Hb: less than 13 g/dl in nonmenstruating females and less than 14 g/dl in males. It is illogical to use significantly lower values in patients with CRI or ESRD in view of increasing recognition that Hb below normal levels is associated with worse outcomes (3,7).…”

Section: Anemia In Crimentioning

confidence: 99%

How Can the Cardiac Death Rate be Reduced in Dialysis Patients?

Besarab

2002

Seminars in Dialysis

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Anaemia in the patient with renal insufficiency: documenting the impact and reviewing treatment strategies

Cited by 18 publications

References 0 publications

Association between depressive symptoms and mortality risk in chronic kidney disease.

Association between depressive symptoms and mortality risk in chronic kidney disease.

Chronic renal insufficiency in children: The 2001 Annual Report of the NAPRTCS

How Can the Cardiac Death Rate be Reduced in Dialysis Patients?

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