Anemia: An early complication of chronic renal insufficiency

Kazmi, Waqar; Kausz, Annamaria T.; Khan, Samina; Abichandani, Rekha; Ruthazer, Robin; Obrador, Gregorio T.; Pereira, Brian J.G.

doi:10.1053/ajkd.2001.27699

Cited by 194 publications

(130 citation statements)

References 27 publications

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“…Therefore, that anemia was more prevalent in the group of subjects with high Scr (15.1%) than in the group with normal Scr (8.7%) was an expected finding (Table 1). These results are not different from those of other studies (32)(33)(34).…”

Section: Discussioncontrasting

confidence: 64%

Association of High Serum Creatinine and Anemia Increases the Risk of Coronary Events

Jurkovitz

Abramson²,

Vaccarino³

et al. 2003

Journal of the American Society of Nephrology

173

108

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Abstract. Coronary heart disease (CHD) is a major cause of morbidity and mortality in patients with chronic kidney disease or anemia. The purpose of this study was to examine whether the association between renal function and risk of CHD is modified by hemoglobin (Hgb) status. Analyses were based on data from the Atherosclerosis Risk in Communities study, a community-based study of risk factors for CHD in middle-aged people. People with known CHD at baseline were excluded from the analysis. Participants were followed for 9 yr for the occurrence of CHD. Anemia was defined as Hgb Ͻ13 g/dl in men and Ͻ12 g/dl in women. Cox proportional hazards models were used to assess the relative risk (RR) of CHD occurrence according to Hgb status, after adjusting for other risk factors (demographics, lipids, diabetes, hypertension, smoking, body mass index, and carotid intima-media thickness). A total of 13,329 participants were included. The interaction between Hgb concentration and serum creatinine (Scr) was significant (P ϭ 0.02). Among people with anemia, a Scr Ն1.2 mg/dl in women or Ն1.5 mg/dl in men was associated with a higher risk of CHD (RR, 2.74; 95% confidence interval, 1.42 to 5.28) than those with normal Scr. In contrast, among those without anemia, this association was not noted (RR, 1.20; 95% confidence interval, 0.86 to 1.67). In conclusion, this study indicates that high Scr is associated with almost a threefold risk of CHD among middle-aged people with anemia, whereas no increased risk is found in people with high Scr in the absence of anemia.Cardiovascular disease (CVD) mortality rates in ESRD are approximately 15 times higher than in the general population (1). Many studies examining the association between ESRD and cardiovascular mortality (2,3) have found that ESRD is an independent predictor of cardiovascular death. However, it is unclear whether moderate renal insufficiency is also associated with cardiovascular events. Previous studies conducted in patients at high risk of CVD have suggested that mild renal insufficiency may be an independent risk factor for cardiovascular events (4 -8). However, in analyses of population-based cohorts (9,10), there was no independent association between moderate renal insufficiency and cardiovascular mortality or nonfatal cardiovascular events after adjustment for traditional risk factors.Anemia is a frequent complication of chronic kidney disease (CKD) and is primarily due to failure of erythropoietin production to respond to decreased hemoglobin (Hgb) concentration (11,12). In chronic anemia, long-lasting flow/volume overload and increased cardiac work lead to progressive cardiac enlargement and left ventricular hypertrophy (13). The risk of coronary heart disease (CHD) increases when the anemia is not treated, and recent studies have indicated that anemia in patients with CKD may predispose to ischemic heart disease, heart failure, and premature death (14 -16). Therefore, the risk of CHD may be distinctly higher in people with renal insufficiency and concomitant ane...

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Section: Discussioncontrasting

confidence: 64%

Association of High Serum Creatinine and Anemia Increases the Risk of Coronary Events

Jurkovitz

Abramson²,

Vaccarino³

et al. 2003

Journal of the American Society of Nephrology

173

108

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“…Although several studies have reported high prevalence of anemia among people with reduced kidney function,26 most investigated clinical populations with advanced kidney failure,27 end‐stage renal disease,28 or diabetic nephropathy 14, 15. In addition, very few studies explored the association between albuminuria and the prevalence of anemia in the general population 29.…”

Section: Discussionmentioning

confidence: 99%

Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: The ARIC (Atherosclerosis Risk in Communities) Study

Ishigami

Grams

Naik

et al. 2018

JAHA

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BackgroundReduced estimated glomerular filtration rate (eGFR) and elevated urinary albumin‐to‐creatinine ratio (ACR) individually increase risk of cardiovascular disease (CVD). We hypothesized that these associations are stronger among people with abnormal (both low and high) hemoglobin levels.Methods and ResultsUsing 5801 participants with available hemoglobin measures of the ARIC (Atherosclerosis Risk in Community) study in 1996–1998, we explored the cross‐sectional association of eGFR and ACR with hemoglobin levels and their longitudinal associations with CVD (heart failure, coronary heart disease, and stroke) risk through 2013. At baseline, 8.8% had anemia (<13 g/dL in men and <12 g/dL in women) and 7.2% had high hemoglobin (≥16 g/dL in men and ≥15 g/dL in women). The adjusted prevalence ratio of anemia was 2.12 (95% confidence interval, 1.59–2.82) for eGFR 30 to 59 compared with ≥90 mL/min per 1.73 m2 and 1.45 (1.07–1.95) for ACR ≥30 compared with <10 mg/g. ACR ≥30 mg/g was also associated with high hemoglobin (prevalence ratio, 1.57 [1.12–2.19] compared with <10 mg/g). During follow‐up, there were 1069 incident CVDs among 5098 CVD‐free participants at baseline. In multivariable Cox models, lower eGFR, higher ACR, and anemia were each independently associated with CVD risk, with the association of low eGFR being slightly stronger in anemia (P‐for‐interaction, 0.072). There was no hemoglobin‐ACR interaction; however, when CVD subtypes were analyzed separately, risk of coronary heart disease and stroke associated with high ACR was slightly stronger in high hemoglobin (P‐for‐interaction, 0.074).ConclusionsKidney function, albuminuria, and anemia were correlated and independently associated with CVD risk. Correlation and potential interaction for atherosclerotic CVD between albuminuria and high hemoglobin deserve further investigation.

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“…The grade of anemia is increased with renal dysfunction, 21 and anemia is a risk factor for renal prognosis and survival. [2][3][4]22 In patients with chronic kidney disease (CKD), renal failure, heart failure, and anemia aggravate each other and lead to the development of cardio-renal anemia syndrome.…”

Section: Discussionmentioning

confidence: 99%

Association of Hypoalbuminemia with Severe Anemia in Patients with Diabetic Nephrosclerosis

et al. 2012

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Background: Anemia in patients with early diabetes mellitus nephrosclerosis (DMN) is more severe than in patients with kidney disease of other origins, and the mechanism for this remains unclear. In this study, we carried out a retrospective study in order to identify the factors associated with anemia in patients with DMN. Methods: To elucidate the factors that influence the severity of anemia in patients with DMN, we carried out a retrospective follow-up study of 124 biopsy-proven DMN cases [mean (SE) age, 55.3 (1.2) years; range, 18-78 years; male/female, 80/44]. First, a cluster analysis was performed using red blood cell counts and hemoglobin (Hb) and hematocrit levels. We then divided the clusters with regard to renal prognosis and survival and carried out simple and multifactorial analysis of clinical data, including the body mass index, age, systolic blood pressure (BP), diastolic BP, duration after the diagnosis of diabetes mellitus, serum albumin levels, blood urea nitrogen (BUN) concentrations, serum creatinine concentrations, the estimated glomerular filtration rate (eGFR) validated in the Japanese population, iron levels, total cholesterol levels, triglyceride levels, fasting blood sugar levels, HbA1c levels, urinary protein secretion, and pathohistological parameters. Results: The factors that were significantly associated with the cluster group that showed severe anemia were sex (p = 0.0162), hypoalbuminemia (p < 0.0001), high BUN concentrations (p = 0.0020), low eGFR (p = 0.0104), and Kimmelstiel-Wilson nodules (p = 0.0022). In addition, hypoalbuminemia (p = 0.0277), high BUN concentrations (p = 0.0338), and a low eGFR (p = 0.0417) were significantly associated with this group in a multifactorial analysis. Conclusion: Our data strongly suggest that hypoalbuminemia is associated with severe anemia in DMN patients.

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Anemia: An early complication of chronic renal insufficiency

Cited by 194 publications

References 27 publications

Association of High Serum Creatinine and Anemia Increases the Risk of Coronary Events

Association of High Serum Creatinine and Anemia Increases the Risk of Coronary Events

Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: The ARIC (Atherosclerosis Risk in Communities) Study

Association of Hypoalbuminemia with Severe Anemia in Patients with Diabetic Nephrosclerosis

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