Anemia among Chinese patients with chronic kidney disease and its association with quality of life - results from the Chinese cohort study of chronic kidney disease (C-STRIDE)

Abstract

Background Anemia is one of the common complications in patients with chronic kidney disease (CKD). However, there is no systematic investigation on the prevalence of anemia in CKD patients and its relationship with the quality of life in China. Methods The data for this study comes from baseline data from the Chinese Chronic Kidney Disease Cohort Study (C-STRIDE), which recruited predialysis CKD patients in China. The kidney disease quality of life summary (KDQOL-TM) was used to assess health-related quality of life (HRQoL). Use linear regression model to estimate the relationship between hemoglobin level and quality of life. Results A total of 2921 patients were included in this study. The adjusted prevalence of hemoglobin (Hb) less than 100 g/L was 10.3% (95% confidence interval [CI]: 9.9,11.4%), and showed an increased trend through reduced eGFR levels from 4.0% (95%CI:2.3,5.9%) in the 45-60 ml/min/1.73m2 group to 23.4% (95%CI:20.5,26.2%) in the 15–29 ml/min/1.73m2 group. The prevalence of anti-anemia treatment was 34.0% (95%CI: 28.7,39.3%) and it is shown by reducing eGFR levels from 15.8% (95%CI:0,36.7%) in the 45-60 ml/min/1.73m2 group to 38.2% (95%CI: 30.7,45.2%) in the 15–29 ml/min/1.73m2 group. All five dimensions of the KDQOL scores in patients with CKD decreased as hemoglobin declined. After multivariable adjustments,the degrees of decrease became somewhat blunted. For example, compared with hemoglobin of ≥130 g/L, regression coefficients in the hemoglobin of < 100 g/L were − 0.047(95%CI: − 0.049,-0.045) for Symptoms and Problems(S), − 0.047(95%CI: − 0.049,-0.044) for Effects of the Kidney Disease(E), − 0.207(95%CI: − 0.212,-0.203) for Burden of the Kidney Disease(B), − 0.112(95%CI: − 0.115,-0.109) for SF-12 Physical Functioning (PCS), − 0.295(95%CI: − 0.299, -0.292) for SF-12 Mental Functioning (MCS), respectively. Conclusions In our cross-sectional analysis of patients with CKD in China, prevalence of both anemia and anti-anemia treatment increased with decreased eGFR. In addition, anemia was associated with reduced HRQoL.

Effect of Anemia on Physical Function and Physical Activity in CKD: The National Health and Nutrition Examination Survey, 1999–2016

“…The CKD Outcomes and Practice Patterns Study, 8 a prospective cohort of 2465 patients with stage 3–5 CKD, found that anemia was associated with lower (worse) overall health-related quality of life and with the emotional and physical domains of health-related quality of life, as well as with physical inactivity. Similar findings were obtained in the CKD RenalSoft Informatics Observational Study, 31 a prospective cohort of 1186 patients with stage 3–5 CKD, that assessed physical functioning using the Kidney Disease Quality of Life Short Form Questionnaire and in the Chinese Cohort Study of CKD, 32 a multicenter prospective cohort of 2921 patients with CKD. Furthermore, a large real-world cross-sectional multicounty survey of 5276 patients with CKD 33 found that lower hemoglobin levels worsened the effect of CKD on health-related quality of life.…”

“…The few studies that have assessed the association between anemia and functional outcomes have been restricted to nondialysis patients with CKD stages 3 or greater 8 , 31 – 33 or restricted to hemodialysis patients. 34 As expected from studies in CKD populations, in all these studies, the mean hemoglobin levels were lower, and the proportion of participants with moderate-to-severe anemia (hemoglobin <10 g/dl) was higher than in our sample.…”

Evolving Strategies in the Treatment of Anaemia in Chronic Kidney Disease: The HIF-Prolyl Hydroxylase Inhibitors

“…A clear and consistent association between anaemia and poorer HRQoL has been repeatedly reported, with more pronounced benefits of higher Hb levels after treatment with ESAs in younger and ND-CKD patients [119][120][121][122][123]. However, improvement in HRQoL strongly attenuates for Hb > 12 g/dL after ESA [124,125], thus confirming that complete correction of anaemia by ESA provides small advantages for selected domains of HRQoL [15,126,127].…”

Prevalence of anemia among chronic kidney disease patients in India: a single-centre study

“…17,18 The stages of CKD were also associated with a high prevalence of anemia. 19,20 This accounts for stages 3, 4, and 5. Patients with higher stages of CKD were found to have severe anemia defined by hemoglobin below 8 g/dl.…”