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New-onset anemia and associated risk of ESKD and death in non-dialysis CKD patients: a multicohort observational study

2022; Oxford University Press; Volume: 15; Issue: 6 Linguagem: Inglês

10.1093/ckj/sfac004

2048-8513

Roberto Minutolo, Michele Provenzano, Paolo Chiodini, Silvio Borrelli, Carlo Garofalo, Michele Andreucci, Maria Elena Liberti, Vincenzo Bellizzi, Giuseppe Conte, Luca De Nicola, Luca De Nicola, Roberto Minutolo, Pasquale Zamboli, F C Iodice, Silvio Borrelli, Paolo Chiodini, Simona Signoriello, Ciro Gallo, Giuseppe Conte, Bruno Cianciaruso, Andrea Pota, Felice Nappi, F Avella, Biagio Di Iorio, Vincenzo Bellizzi, R Cestaro, V Martignetti, Luigi Morrone, Antonio Lupo, Cataldo Abaterusso, Carlo Donadio, Mario Bonomini, Vittorio Sirolli, Francesco Gaetano Casino, Thais Lizondo López, F Detomaso, Michele Giannattasio, Mary Virgilio, G Tarantino, Claudio Di Cristofano, S Tuccillo, Sonia Nagy Chimienti, Francesca Petrarulo, Vincenzo Giancaspro, Marie‐Pierre F. Strippoli, E. Laraia, Michele Gallucci, Bruna Gigante, C Lodeserto, D. Santese, Ashley Montanaro, Raffaele Giordano, Alfredo Caglioti, Giorgio Fuíano, Carmine Zoccali, Gianluca Caridi, Maurizio Postorino, Vincenzo Savica, Paolo Monardo, Guido Bellinghieri, Domenico Santoro, Pietro Castellino, Francesco Rapisarda, Pasquale Fatuzzo, Antonio Messina, Antonio Dal Canton, Vittoria Esposito, Marco Formica, Giuseppe Segoloni, Maurizio Gallieni, Francesco Locatelli, R Tarchini, Gina Meneghel, Lamberto Oldrizzi, Maria Vittoria Cossu, S. Di Giulio, Moreno Malaguti, Francesco Pizzarelli, Giuseppe Quintaliani, Bruno Cianciaruso, Antonio Pisani, Giuseppe Conte, Luca De Nicola, Roberto Minutolo, Renzo Bonofiglio, Giorgio Fuíano, Giuseppe Grandaliano, Guido Bellinghieri, Domenico Santoro, Bruno Cianciaruso, Domenico Russo, Andrea Pota, Lucia Di Micco, Serena Torraca, Massimo Sabbatini, Antonio Pisani, Vincenzo Bellizzi,

Iron Metabolism and Disorders

ABSTRACT Background Anemia is a common complication of chronic kidney disease (CKD), but its incidence in nephrology settings is poorly investigated. Similarly, the risks of adverse outcomes associated with new-onset anemia are not known. Methods We performed a pooled analysis of three observational cohort studies including 1031 non-anemic CKD patients with eGFR <60 mL/min/1.73 m2 regularly followed in renal clinics. We estimated the incidence of mild anemia (hemoglobin 11–12 g/dL in women and 11–13 g/dL in men) and severe anemia (hemoglobin <11 g/dL or use of erythropoiesis-stimulating agents) during a 3-year follow-up period. Thereafter we estimated the risk of end-stage kidney disease (ESKD) and all-cause death associated with new-onset mild and severe anemia. Results The mean age was 63 ± 14 years, 60% were men and 20% had diabetes. The mean estimated glomerular filtration rate (eGFR) was 37 ± 13 mL/min/1.73 m2 and the median proteinuria was 0.4 g/day [interquartile range (IQR) 0.1–1.1]. The incidence of mild and severe anemia was 13.7/100 patients-year and 6.2/100 patients-year, respectively. Basal predictors of either mild or severe anemia were diabetes, lower hemoglobin, higher serum phosphate, eGFR <30 mL/min/1.73 m2 and proteinuria >0.50 g/day. Male sex, moderate CKD (eGFR 30–44 mL/min/1.73 m2) and moderate proteinuria (0.15–0.50 g/day) predicted only mild anemia. The incidence of anemia increased progressively with CKD stages (from 8.77 to 76.59/100 patients-year) and the proteinuria category (from 13.99 to 25.02/100 patients-year). During a median follow-up of 3.1 years, 232 patients reached ESKD and 135 died. Compared with non-anemic patients, mild anemia was associated with a higher adjusted risk of ESKD {hazard ratio [HR] 1.42 [95% confidence interval (CI) 1.02–1.98]} and all-cause death [HR 1.55 (95% CI 1.04–2.32)]. Severe anemia was associated with an even higher risk of ESKD [HR 1.73 (95% CI 1.20–2.51)] and death [HR 1.83 (95% CI 1.05–3.19)]. Conclusions New-onset anemia is frequent, particularly in patients with more severe renal damage and in those with diabetes mellitus. The occurrence of anemia, even of a mild degree, is associated with mortality risk and faster progression towards ESKD.