Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: The ARIC Study

Abramson, Jerome L.; Jurkovitz, Claudine; Vaccarino, Viola; Weintraub, William S.; McClellan, William M.

doi:10.1046/j.1523-1755.2003.00109.x

Cited by 295 publications

(217 citation statements)

References 24 publications

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“…Anemia is highly prevalent among people with reduced kidney function attributed to decreased synthesis of erythropoietin,7 iron deficiency,8 and chronic inflammation,9 and it contributes to increased cardiac workload10 and left ventricular hypertrophy 11. Previous studies showed that the association of reduced kidney function was stronger in anemia with the risk of coronary heart disease12 and stroke 13…”

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confidence: 99%

Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: The ARIC (Atherosclerosis Risk in Communities) Study

Ishigami

Grams

Naik

et al. 2018

JAHA

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BackgroundReduced estimated glomerular filtration rate (eGFR) and elevated urinary albumin‐to‐creatinine ratio (ACR) individually increase risk of cardiovascular disease (CVD). We hypothesized that these associations are stronger among people with abnormal (both low and high) hemoglobin levels.Methods and ResultsUsing 5801 participants with available hemoglobin measures of the ARIC (Atherosclerosis Risk in Community) study in 1996–1998, we explored the cross‐sectional association of eGFR and ACR with hemoglobin levels and their longitudinal associations with CVD (heart failure, coronary heart disease, and stroke) risk through 2013. At baseline, 8.8% had anemia (<13 g/dL in men and <12 g/dL in women) and 7.2% had high hemoglobin (≥16 g/dL in men and ≥15 g/dL in women). The adjusted prevalence ratio of anemia was 2.12 (95% confidence interval, 1.59–2.82) for eGFR 30 to 59 compared with ≥90 mL/min per 1.73 m2 and 1.45 (1.07–1.95) for ACR ≥30 compared with <10 mg/g. ACR ≥30 mg/g was also associated with high hemoglobin (prevalence ratio, 1.57 [1.12–2.19] compared with <10 mg/g). During follow‐up, there were 1069 incident CVDs among 5098 CVD‐free participants at baseline. In multivariable Cox models, lower eGFR, higher ACR, and anemia were each independently associated with CVD risk, with the association of low eGFR being slightly stronger in anemia (P‐for‐interaction, 0.072). There was no hemoglobin‐ACR interaction; however, when CVD subtypes were analyzed separately, risk of coronary heart disease and stroke associated with high ACR was slightly stronger in high hemoglobin (P‐for‐interaction, 0.074).ConclusionsKidney function, albuminuria, and anemia were correlated and independently associated with CVD risk. Correlation and potential interaction for atherosclerotic CVD between albuminuria and high hemoglobin deserve further investigation.

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confidence: 99%

Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: The ARIC (Atherosclerosis Risk in Communities) Study

Ishigami

Grams

Naik

et al. 2018

JAHA

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“…7 Published data suggest that anemia is an independent risk factor for cardiovascular morbidity and mortality, 8 and the combination of anemia and CKD is associ-ated with a significantly higher stroke risk. 9 CVD is the foremost cause of mortality in the CKD population, accounting for nearly half of the overall mortality. 10 Even mild renal insufficiency is linked to a higher risk of cardiovascular events.…”

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confidence: 99%

Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study

Salman

Khan

Adnan

et al. 2016

Rev. Assoc. Med. Bras.

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Summary Objective: Anemia, a common complication of chronic kidney diseases (CKD), is involved in significant cardiovascular morbidity. Therefore, the objective of our study was to investigate the prevalence and severity of anemia in pre-dialysis patients, as well as to determine the predictors of anti-anemic therapy. Method: A retrospective, observational study was conducted on adult pre-dialysis patients receiving treatment at the Hospital Universiti Sains Malaysia from January 2009 to December 2013. Results: A total of 615 eligible cases were included. The mean age of patients was 64.1±12.0 years. The prevalence of anemia was 75.8%, and the severity of anemia was mild in 47.7% of the patients, moderate in 32.2%, and severe in 20%. Based on morphological classification of anemia, 76.9% of our patients had normochromic-normocytic anemia whereas 21.8 and 1.3% had hypochromic-microcytic anemia and macrocytic anemia, respectively. Oral iron supplements were prescribed to 38.0% of the patients and none of the patients was given erythropoietin stabilizing agents (ESA) or intravenous iron preparations. In logistic regression, significant predictors of anti-anemic preparation use were decreased hemoglobin and hematocrit, and advanced stages of CKD. Conclusion: The results of the present study suggest that the prevalence of anemia in pre-dialysis patients is higher than currently accepted and it is found to be correlated with renal function; prevalence increases with declined renal function. An earlier identification as well as appropriate management of anemia will not only have a positive impact on quality of life but also reduce hospitalizations of CKD patients due to cardiovascular events.

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“…n patients who have chronic kidney disease (CKD) and are not yet on hemodialysis (HD), anemia has a significant prevalence, rising from approximately 15 to 70% in stages 3 to 5 (1-4), and acts as an independent risk factor for cardiovascular disease (2,(5)(6)(7)(8) and ESRD (8 -10). These findings have led to the recommendations, recently reiterated by European (European Best Practice Guidelines) and US (Kidney Disease Outcomes Quality Initiative) clinical practice guidelines (11,12), to prescribe erythropoiesis-stimulating agents (ESA) to maintain hemoglobin Ն11 g/dl in all patients with CKD.…”

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Stability of Target Hemoglobin Levels during the First Year of Epoetin Treatment in Patients with Chronic Kidney Disease

Nicola¹,

Conte²,

Chiodini³

et al. 2007

Clinical Journal of the American Society of Nephrology

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Background and Objectives: Instability of hemoglobin levels during epoetin therapy is a new problem in hemodialysis. We evaluated extent and correlates of time in target, that is, the time spent with hemoglobin >11 g/dl during the first year of epoetin and its association with renal survival.Design, Setting, Participants, & Measurements: Data were collected in 917 visits for 12.0 mo in 119 patients with chronic kidney disease; thereafter, patients started renal survival analysis for 10.1 mo. At baseline, hemoglobin was 10.0 ؎ 0.8 g/dl and GFR was 22.1 ؎ 14.2 ml/min per 1.73 m 2 . Results: Hemoglobin target, reached in 1.5 mo, was steadily maintained in only 24% of patients. Time in target was not merely due to differences in time to target; after first achievement of target, in fact, a reduction of hemoglobin <11 g/dl occurred in 51% of patients. At multivariate analysis, male gender, basal GFR and hemoglobin levels, first epoetin dose, and iron supplementation were directly associated with length of time in target. A lower risk for renal death (dialysis n ‫؍‬ 53; death n ‫؍‬ 8) was detected in the higher tertile of time in target (11.3 mo) versus lower tertile (3.2 mo). This difference persisted at Cox analysis after adjustment for age, gender, GFR, BP, and proteinuria.Conclusions: In chronic kidney disease, time in target during the first year of epoetin therapy is frequently short depending not only on time to target but also on post-target hemoglobin reductions, correlates with male gender, timing, and intensity of initial therapy and is coupled with better renal survival.

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Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: The ARIC Study

Abstract: Among middle-aged, community-based persons, the combination of CKD and anemia was associated with a substantial increase in stroke risk, independent of other known risk factors for stroke.

Cited by 295 publications

References 24 publications

Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: The ARIC (Atherosclerosis Risk in Communities) Study

Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: The ARIC (Atherosclerosis Risk in Communities) Study

Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study

Stability of Target Hemoglobin Levels during the First Year of Epoetin Treatment in Patients with Chronic Kidney Disease

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