Effects of Anemia and Left Ventricular Hypertrophy on Cardiovascular Disease in Patients with Chronic Kidney Disease

Weiner, Daniel E.; Tighiouart, Hocine; Vlagopoulos, Panagiotis T.; Griffith, John L.; Salem, Deeb N.; Levey, Andrew S.; Sarnak, Mark J.

doi:10.1681/asn.2004070597

Cited by 190 publications

(133 citation statements)

References 26 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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“…Only a few of the historical prospective and retrospective studies in dialysis patients have analyzed, with adjustments for comorbidities, the association between hemoglobin level and outcome (43)(44)(45)(46). These studies have generally shown a strong and consistent association between higher hemoglobin or hematocrit levels and better outcome (43)(44)(45)(46)(47)(48)(49).…”

Section: Anemia and Hdmentioning

confidence: 95%

Improving Outcomes for Dialysis Patients in the International Dialysis Outcomes and Practice Patterns Study

Port

Pisoni

Bommer

et al. 2006

Clinical Journal of the American Society of Nephrology

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The international Dialysis Outcomes and Practice Patterns Study (DOPPS) is well suited to evaluate levels of deviation from emerging and established guidelines to clinical practice of hemodialysis, over time and by country. The DOPPS can also evaluate whether the target levels that are chosen in the guidelines are in agreement with outcomes such as elevated risk for mortality, hospitalization, and vascular access failure. At a special DOPPS symposium during the 2004 congress of the American Society of Nephrology, the authors presented such findings; key points from that symposium are presented in this article, focusing on vascular access, mineral metabolism, dialysis dose, and anemia management. Although an observational study cannot prove causality, DOPPS suggests large opportunities to improve care and outcomes of dialysis patients. The international perspective of DOPPS assists in the new efforts for international guidelines. Some encouraging trends in recent years are documented in these areas.

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“…Left ventricular hypertrophy (LVH) was defined on the basis of electrocardiogram criteria. 24 BMI was calculated as (weight in kg/height in m 2 ). Diuretic use included thiazide, loop, and potassium-sparing diuretics, because the limited access data did not universally differentiate diuretic class.…”

Section: Other Variablesmentioning

confidence: 99%

Uric Acid and Incident Kidney Disease in the Community

Weiner¹,

Tighiouart

Elsayed³

et al. 2008

Journal of the American Society of Nephrology

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299

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Uric acid may mediate aspects of the relationship between hypertension and kidney disease via renal vasoconstriction and systemic hypertension. To investigate the relationship between uric acid and subsequent reduced kidney function, limited-access data of 13,338 participants with intact kidney function in two community-based cohorts, the Atherosclerosis Risks in Communities and the Cardiovascular Health Study, were pooled. Mean baseline serum uric acid was 5.9 Ϯ 1.5 mg/dl, mean baseline serum creatinine was 0.9 Ϯ 0.2 mg/dl, and mean baseline estimated GFR was 90.4 Ϯ 19.4 ml/min/1.73 m 2 . During 8.5 Ϯ 0.9 yr of follow-up, 712 (5.6%) had incident kidney disease defined by GFR decrease (Ն15 ml/min/1.73 m 2 with final GFR Ͻ60 ml/min/1.73 m 2 ), while 302 (2.3%) individuals had incident kidney disease defined by creatinine increase (Ն0.4 mg/dl with final serum creatinine Ͼ1.4 mg/dl in men and 1.2 mg/dl in women). In GFR-and creatinine-based logistic regression models, baseline uric acid level was associated with increased risk for incident kidney disease (odds ratio 1.07 [95% confidence interval 1.01 to 1.14] and 1.11 [95% confidence interval 1.02 to 1.21] per 1-mg/dl increase in uric acid, respectively), after adjustment for age, gender, race, diabetes, systolic BP, hypertension, cardiovascular disease, left ventricular hypertrophy, smoking, alcohol use, education, lipids, albumin, hematocrit, baseline kidney function and cohort; therefore, elevated serum uric acid level is a modest, independent risk factor for incident kidney disease in the general population.

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Effects of Anemia and Left Ventricular Hypertrophy on Cardiovascular Disease in Patients with Chronic Kidney Disease

Cited by 190 publications

References 26 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

Improving Outcomes for Dialysis Patients in the International Dialysis Outcomes and Practice Patterns Study

Uric Acid and Incident Kidney Disease in the Community

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