Associations of Hemoglobin Levels With Health-Related Quality of Life, Physical Activity, and Clinical Outcomes in Persons With Stage 3-5 Nondialysis CKD

Abstract

, MS, † and on behalf of CKDopps Investigators* Objective: Conflicting findings and knowledge gaps exist regarding links between anemia, physical activity, health-related quality of life (HRQOL), chronic kidney disease (CKD) progression, and mortality in moderate-to-advanced CKD. Using the CKD Outcomes and Practice Patterns Study, we report associations of hemoglobin (Hgb) with HRQOL and physical activity, and associations of Hgb and physical activity with CKD progression and mortality in stage 3-5 nondialysis (ND)-CKD patients. Design and Methods: Prospectively collected data were analyzed from 2,121 ND-CKD stage 3-5 patients, aged $18 years, at 43 nephrologist-run US and Brazil CKD Outcomes and Practice Patterns Study-participating clinics. Cross-sectional associations were assessed of Hgb levels with HRQOL and physical activity levels (from validated Kidney Disease Quality of Life Instrument and Rapid Assessment of Physical Activity surveys). CKD progression (first of $40% estimated glomerular filtration rate [eGFR] decline, eGFR,10 mL/min/1.73 m 2 , or end-stage kidney disease) and all-cause mortality with Hgb and physical activity levels were also evaluated. Linear, logistic, and Cox regression analyses were adjusted for country, demographics, smoking, eGFR, serum albumin, very high proteinuria, and 13 comorbidities. Results: HRQOL was worse, with severe anemia (Hgb,10 g/dL), but also evident for mild/moderate anemia (Hgb 10-12 g/dL), relative to Hgb.12 g/dL. Odds of being highly physically active were substantially greater at Hgb.10.5 g/dL. Lower Hgb was strongly associated with greater CKD progression and mortality, even after extensive adjustment. Physical inactivity was strongly associated with greater mortality and weakly associated with CKD progression. Possible residual confounding is a limitation. Conclusion: This multicenter international study provides real-world observational evidence for greater HRQOL, physical activity, lower CKD progression, and greater survival in ND-CKD patients with Hgb levels .12 g/dL, exceeding current treatment guideline recommendations. These findings help inform future studies aimed at understanding the impact of new anemia therapies and physical activity regimens on improving particular dimensions of ND-CKD patient well-being and clinical outcomes.

The Association of Hemoglobin Levels With Quality of Life and Physical Activity in Hemodialysis Patient in Wangaya Regional General Hospital, Denpasar

“…From the data analysis, the hemoglobin level was not correlated with physical activity level (p=1.000). This finding differs from the previous studies [13,33]. Hoshino et al also found declining physical activity level decreased proportionally with lower Hb levels between 10.5 g/ dL and 13 g/dL [13].…”

“…This finding differed from Hoshino et al and Finkelstein et al studies which found that hemoglobin levels >12 g/dL were associated with a higher quality of life comparing to lower hemoglobin levels [13,27]. This difference might be caused by different studies' subjects.…”

“…Anemia in CKD was also associated with the disease progression, increased mortality rate, and unfavorable outcome [12]. A study from Hoshino et al showed that increased hemoglobin levels alleviated some symptoms in CKD such as depressions and insomnia in non-hemodialysis patients [13].…”

Management of Anemia in Nondialysis Chronic Kidney Disease: Current Recommendations, Real-World Practice, and Patient Perspectives

“…Anemia has been consistently associated with poor outcomes in patients with ND-CKD. In fact, recent reports from the Chronic Kidney Disease Outcomes and Practice Patterns Study (CKDopps) (9) showed a negative association of lower Hb with CKD progression and all-cause mortality (10). Indeed, in an analysis of four community-based longitudinal studies, anemia was associated with a 51% increase in the composite of myocardial infarction, stroke, and all-cause mortality (11).…”

“…In an analysis of patients with ND-CKD in The Netherlands, individuals with Hb,11 g/dl had considerably worse HRQoL for both physical and mental components of the Short-Form 36 (SF-36) than those with Hb above 11 g/dl (13). An analysis of data from 2121 individuals included in the CKDopps provided evidence that Hb had a positive monotonic association with HRQoL even extending to .12 g/dl (10).…”