Anemia Development and Cardiovascular Risk Management in Nonanemic Stage 3 Chronic Kidney Disease

Abstract

Background/Aim. There is little information on the development of anemia in the early stages of chronic kidney disease. The aim of this study was to analyze the onset of renal anemia in a cohort of initially nonanemic chronic kidney disease patients followed up in nephrology clinics. Methods. This epidemiological, prospective, three-year, multicenter study enrolled patients aged 18-78 years with stage 3 chronic kidney disease without anemia. Interim analysis was performed on the data collected during the first 12 months. Results. The study included 432 patients, average age 63.6 years (range 22-78 years, 70% male). The main etiologies of chronic kidney disease were glomerular (11.6%), interstitial (10.4%), vascular (29.4%), and diabetic (16.9%). The percentages of patients with comorbidities were 33.8% diabetes (2.5% type 1), 69% dyslipidemia, and 93% hypertension. During the first year, 12.4% of patients developed anemia. The chronic kidney disease progression rate was low: proteinuria was 0.46 ± 0.8 g/24 h at one year versus 0.67 ± 1.0 g/24 h at baseline. Diabetic patients showed a greater prevalence of previous cardiovascular events (50.0% vs. 24.5%) and worse control of some modifiable cardiovascular risk factors: smoking (13.4% vs. 8.6%), obesity (BMI > 30 kg/m 2 , 33.6% vs. 25.3%), target blood pressure (<130/80 mmHg, 21.0% vs. 27.9%), and proteinuria (0.8 ± 1.1 vs. 0.6 ± 0.9 g/day). Conclusions. After one year, 12.4% of patients developed anemia. Diabetic patients had a higher cardiovascular risk and limited blood pressure control. The overall control of cardiovascular risk was unsatisfactory.

The development of anemia is associated to poor prognosis in NKF/KDOQI stage 3 chronic kidney disease

“…The prevalence of anemia at the end of the follow-up period in our cohort was only slightly lower than that previously reported in transversal studies, but comparison is difficult due to the significant differences in study design and patient populations. A previous preliminary interim analysis of this study showed that 12.4% of patients developed anemia during the first year of follow-up [14]. In this final analysis, prevalence increased by about 10% per year in a real setting of follow-up in nephrology services, and was accompanied by renal function decline of 1.1 mL/min per year.…”

“…We have found that patients that developed anemia had significantly lower baseline eGFR and higher proportion of significant proteinuria (>1 g/24h) [10,14]. However, proteinuria did not have prognostic value in the multivariate model including initial eGFR, Hb, and gender.…”