Anemia and Renal Insufficiency Are Independent Risk Factors for Death among Patients with Congestive Heart Failure Admitted to Community Hospitals

McClellan, William M.; Flanders, W. Dana; Langston, Robert D; Jurkovitz, Claudine; Presley, Rodney

doi:10.1097/01.asn.0000018409.45834.fa

Cited by 418 publications

(335 citation statements)

References 34 publications

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“…Hypoxiainduced altered renal sympathetic nerve activity may differentially regulate glomerular haemodynamics [28]. Close associations between anaemia and cardiac disorders, including left ventricular (LV) hypertrophy and heart failure [29,30], may also provide a basis for explaining the anaemia-induced loss of kidney function in diabetes, as these conditions are associated with decreased effective renal blood flow. Indeed, an increase in LV mass has been reported to occur early in the course of diabetic nephropathy.…”

Section: Discussionmentioning

confidence: 99%

Lower haemoglobin level and subsequent decline in kidney function in type 2 diabetic adults without clinical albuminuria

et al. 2006

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Aims/hypothesis: Anaemia has been suggested to be an independent risk factor for subsequent progression of advanced diabetic nephropathy; however, the relationship between haemoglobin levels and progression of nephropathy in patients without clinical albuminuria is unknown. Methods: We conducted this prospective hospital-based cohort study of 464 type 2 diabetic patients (149 women and 315 men, 55±13 [mean±SD] years of age) with serum creatinine <177 μmol/l (2.00 mg/dl) and urinary albumin : creatinine ratio <300 mg/g creatinine. GFR was estimated using the equation formulated by the Modification of Diet in Renal Disease Study group, refitted for Japanese individuals. Most patients had haemoglobin concentrations in the normal range (144±15 g/l), only modest renal impairment (GFR: 74.8±14.5 ml min −1 1.73 m −2 ), and normal urinary albumin levels (81.5/18.5% with normo-/microalbuminuria). The primary outcome measurement was the rate of change in GFR determined by regression analysis with GFR as a function of time. Patients were followed up for a mean observation period of 5.0±0.9 (range: 2.5 to 6.2) years. Results: Univariate and multiple regression analyses yielded a significant association between the rate of change in GFR and baseline haemoglobin concentration. After adjusting for covariates, the rate of decline in GFR was significantly greater in patients in the lowest haemoglobin quartile (−3.27 ml min −1 1.73 m −2 year −1 ) than in the third (−2.71 ml min −1 1.73 m −2 year −1 , p=0.024) and highest quartiles (−2.78 ml min −1 1.73 m −2 year −1 , p=0.046). Conclusions/interpretation: Lower haemoglobin concentrations in type 2 diabetic patients without clinical albuminuria may be a significant predictor of subsequent decline in GFR.

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Section: Discussionmentioning

confidence: 99%

Lower haemoglobin level and subsequent decline in kidney function in type 2 diabetic adults without clinical albuminuria

et al. 2006

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“…GFR was included in the model to control for renal function, but the interaction between renal function and anemia was not studied. Low Hgb increases also the risk of death in patients with heart failure independent of renal function (16,28). Other investigators have described a U-shaped relationship between hematocrit levels and risk of CVD (29 -31).…”

Section: Discussionmentioning

confidence: 99%

“…Left ventricular hypertrophy predisposes to heart failure or ischemic heart disease and ultimately premature death (15,16,43).…”

Section: Discussionmentioning

confidence: 99%

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

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172

107

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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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“…Indeed, renal failure and anemia were found in some studies to have an additive effect on mortality. 2,53 In 9 studies that examined the relationship between anemia and the number and/or duration of hospitalizations (Tables 2 and 3), all 9 (100%) showed that anemic patients were hospitalized more often and/or for a longer period of time than non-anemics. In addition, in 2 studies, the cost of hospitalization for anemic CHF patients was found to be higher than for non-anemic CHF patients.…”

Section: What Is the Significance Of This Anemia In Chf?mentioning

confidence: 99%

The Role of Anemia in the Progression of Congestive Heart Failure: Is There a Place for Erythropoietin and Intravenous Iron?

Silverberg

Wexler

Iaina

et al. 2008

Transfusion Alternatives in Transfusion Medicine

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Anemia and Renal Insufficiency Are Independent Risk Factors for Death among Patients with Congestive Heart Failure Admitted to Community Hospitals

Cited by 418 publications

References 34 publications

Lower haemoglobin level and subsequent decline in kidney function in type 2 diabetic adults without clinical albuminuria

Lower haemoglobin level and subsequent decline in kidney function in type 2 diabetic adults without clinical albuminuria

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

The Role of Anemia in the Progression of Congestive Heart Failure: Is There a Place for Erythropoietin and Intravenous Iron?

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