Anemia and Kidney Function Decline among the Middle-Aged and Elderly in China: A Population-Based National Longitudinal Study

Yang, Chao; Meng, Qinqin; Wang, Huaiyu; Wang, Yafeng; Su, Zaiming; Liu, Huan; Liu, Wenwen; Kong, Guilan; Zhang, Luxia; Zhao, Yaohui; Zhao, Ming‐Hui

doi:10.1155/2020/2303541

Cited by 10 publications

(16 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This was more prevalent among patients with baseline anemia and those with advanced CKD and could be related to low baseline ESA use (and thus less stability in Hb levels). Similar to results from previous studies [ 24–27 ], presence of anemia was associated with a decline in kidney function, as demonstrated by patients with anemia having an eGFR decrease of more than double that of patients without anemia.…”

Section: Discussionsupporting

confidence: 90%

Contemporary outcomes of anemia in US patients with chronic kidney disease

Wittbrodt

James

Kumar

et al. 2021

Clinical Kidney Journal

View full text Add to dashboard Cite

Background Long-term clinical outcome data from patients with non-dialysis-dependent chronic kidney disease (NDD-CKD) are lacking. We characterized patients with NDD-CKD and anaemia using real-world data from the US. Methods This retrospective longitudinal observational study evaluated integrated Limited Claims and Electronic Health Record Data (IBM Health, Armonk, New York), including patients ≥18 years with ≥2 estimated glomerular filtration rate (eGFR) measures <60 mL/min/1.73 m2 ≥90 days apart. Anaemia was defined as the first observed haemoglobin <10 g/dL within 6-months pre- and post-CKD index date. Data were analysed from January 2012 to June 2018. Patients with documented iron-deficiency anaemia at baseline were excluded. Results Comprising 22,720 patients (57.4% female, 63.9% CKD stage 3, median haemoglobin 12.5 g/dL), median (interquartile range) follow-up for patients with and without anaemia were 2.9 (1.5–4.4) and 3.8 (2.2–4.8) years, respectively. The most prevalent comorbidities were dyslipidaemia (57.6%), type 2 diabetes mellitus (38.8%) and uncontrolled hypertension (20.0%). Overall, 23.3% of patients had anaemia, of whom 1.9% and <0.1% received erythropoiesis-stimulating agents (ESAs) or intravenous iron, respectively. Anaemia prevalence increased with CKD stage from 18.2% (stage 3a) to 72.8% (stage 5). Patients with anaemia had a higher incidence rate of hospitalizations for heart failure (1.6 versus 0.8 per 100 patient-years), CKD stage advancement (43.5 versus 27.5 per 100 patient-years), and a 40% eGFR decrease (18.1 versus 7.3 per 100 patient-years) versus those without anaemia. Conclusions Anaemia, frequently observed in NDD-CKD and associated with adverse clinical outcomes, is rarely treated with ESAs and intravenous iron. These data suggest that opportunities exist for improved anaemia management in patients with NDD-CKD.

show abstract

Section: Discussionsupporting

confidence: 90%

Contemporary outcomes of anemia in US patients with chronic kidney disease

Wittbrodt

James

Kumar

et al. 2021

Clinical Kidney Journal

View full text Add to dashboard Cite

show abstract

“…Additionally, we observed that individuals who aged 60 years or older having a higher risk of CKD. This was similar to previous publication(32), which found the kidney function decline and CKD were more common in the elderly population. Moreover, We observed significant relationship of the risk of subsequent kidney disease in those with lower education level or worse financial status during childhood when exposure to ACEs.…”

Section: Discussionsupporting

confidence: 93%

Association of adverse childhood experiences with subsequent kidney disease among middle-aged and older adults in China: A national analysis

Shi

Huang

Jin

2022

Preprint

View full text Add to dashboard Cite

ObjectiveFew studies have been performed to address the impacts of adverse childhood experiences (ACEs) on kidney function in later life. We aimed to investigate the association between ACEs with subsequent kidney disease among middle-aged and older adults.MethodsThis national population-based study used data from the China Health and Retirement Longitudinal Study (CHARLS) 2015 and the life history survey in 2014. A total of 10102 participants aged ≥ 45 years from China were included. A wide range of 11 ACE indicators including childhood hunger, child’s poor health, physical abuse, emotional neglect, loneliness, peer bullying, domestic violence, household mental illness, household substance abuse, parental death, and incarcerated household member were measured by validated questionnaires. The cumulative number of ACEs was summed and and classified into four subgroups: ≤ 1, 2, 3 and ≥ 4. Glomerular filtration rate (eGFR) was estimated by serum cystatin C concentration and chronic kidney disease (CKD) was defined as eGFR < 60 ml/min/1.73m2. Multiple regression models were used to explore the relationship between accumulated ACEs and individual ACE indicator with subsequent kidney function.FindingsOf the 10102 participants, 46.8% were males, and 16.0% reported exposure to four or more ACEs. Compared those with ≤ 1 ACE, participants who experienced four or more ACEs have a higher risk of decreased eGFR (β= -1.169, 95%CI: -2.113 to -0.225) and CKD (adjusted odds ratio, aOR=1.35, 1.04-1.75), after controlling for confounders. Exposure to specific ACE indicators of childhood poor health, physical abuse and household mental illness presented significant associations with reduced eGFR. The effects were more evident in men aged ≥ 60 years, with lower education or worse financial status.ConclusionsOur study suggests that higher ACEs exposure increased the risk of subsequent kidney disease. The findings provide implications for mitigating the adverse effects of early-life stress and promoting kidney health by reducing ACEs.

show abstract

“…In this study, predict factors of RKFD included 5 variables: age, baseline eGFR, hemoglobin concentration, SBP, and diabetes. This nding was partly consistent with those of prior studies (4,8,(18)(19)(20)(21). In a community-based retrospective cohort study among 51,938 adults who underwent annual medical examinations between 1999 and 2013, it observed older age, higher SBP, proteinuria, and smoking were related to faster loss of kidney function (19).…”

Section: Discussionsupporting

confidence: 91%

“…These results clearly emphasize that SBP is an important correlated factor for faster loss of kidney function. Anemia is also an independent risk factor for progression of kidney function among the middle-aged and elderly population (21). As we all known, CKD often complicated anemia mainly due to iron de ciency and erythropoietin de ciency (22)(23).…”

Section: Discussionmentioning

confidence: 99%

“…On the contrary, anemia could also contribute to kidney function decline, the mainly relevant mechanism is hypoxia and/or increased oxidative stress (24). Anemia decrease the oxygen delivery to tissues and thus affects organ function including kidney and cardiac function (21). For the baseline eGFR,the stage of baseline eGFR has been added to the risk prediction equation for incident CKD(8, 25), and we found the baseline eGFR also contributed to the rapid eGFR decline (HR = 1.022, 95%CI 1.019-1.025), this further con rmed that the baseline value of eGFR is a predictor for rapid kidney function decline(26).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Nomogram to Predict Rapid Kidney Function Decline in Population at Risk of Cardiovascular Disease

Zhang¹,

Lu²,

Li³

et al. 2021

Preprint

View full text Add to dashboard Cite

Background To develop a simple model to predict risk of rapid kidney function decline (RKFD) in population at risk of cardiovascular disease. Methods 8455 subjects aged ≥ 65 years or complicated diabetes or hypertension undergoing community annual health examinations between January 2015 and December 2020 were included. All participants were randomly assigned to a development cohort and a validation cohort in a 2:1 ratio. Rapid kidney function decline was defined as the reduction of estimated glomerular filtration rate (eGFR)≥40% during follow-up period. Cox regression analysis and stepwise approach were used to identify the risk factors. A nomogram based on these predictors was then developed, and discrimination, calibration and decision curve analysis were assessed. Results During the median follow-up period of 3.72 years, the incidence of rapid kidney function decline was 11.96% (n = 1011), 11.98% (n = 676) and 11.92% (n = 335) in the entire cohort, development cohort and validation cohort, respectively. Age, eGFR, hemoglobin, systolic blood pressure, and diabetes were identified as predictors for RKFD. The nomogram demonstrated a good discriminative power with the 5-year AUCs of 0.763 and 0.740 in the development and the validation cohort, respectively. Calibration plots also demonstrated a good fitness between the observed and predicted risk in both cohorts. Conclusions Risk stratification for rapid kidney function decline is achievable using a risk prediction nomogram based on clinical factors that are readily accessible in primary care. The utility of this nomogram in identifying individuals at high risk of RKFD in the community needs further investigation.

show abstract

Anemia and Kidney Function Decline among the Middle-Aged and Elderly in China: A Population-Based National Longitudinal Study

Cited by 10 publications

References 32 publications

Contemporary outcomes of anemia in US patients with chronic kidney disease

Contemporary outcomes of anemia in US patients with chronic kidney disease

Association of adverse childhood experiences with subsequent kidney disease among middle-aged and older adults in China: A national analysis

Nomogram to Predict Rapid Kidney Function Decline in Population at Risk of Cardiovascular Disease

Contact Info

Product

Resources

About