Anemia correlates with cardiovascular disease, lower eGFR, additional adverse outcomes
Click Here to Manage Email Alerts
Anemia independently correlated with lower eGFR and an increased risk of end-stage kidney disease, cardiovascular disease, coronary heart disease, stroke, heart failure and death, according to recently published data.
“Iron deficiency is a common cause of anemia and, although it is recommended that all chronic kidney disease patients with anemia be screened and treated for iron deficiency, it is unclear how often this is occurring in practice,” Danielle K. Farrington, MD, MHS, from the division of nephrology in the department of medicine at Johns Hopkins University School of Medicine in Maryland, and colleagues wrote. “There are also very limited data available on the prevalence of vitamin B12 deficiency, another easily treatable cause of anemia, in those with CKD. In addition, the relative frequency of erythropoiesis-stimulating agent (ESA) use in the non-dialysis CKD population is uncertain.”
In a cross-sectional and prospective cohort study, researchers examined 5,004,957 patients receiving routine medical care from 57 outpatient health care centers across the U.S. between 2016 and 2019. Data were derived from the Optum Labs Data Warehouse. Patients with cancer or requiring dialysis were excluded from the study.
Baseline measurements included hemoglobin, creatinine and ESA. Severity of anemia, low iron test results and eGFR were considered exposures in the study.
Researchers collected follow-up data from patients until 2019. Primary outcomes included incident end-stage kidney disease, cardiovascular disease, coronary heart disease, stroke, heart failure and death.
Researchers characterized the prevalence of anemia, low iron test results, vitamin B12 deficiency and ESA use by stratifying these variables by sex and eGFR. Additionally, researchers used polychotomous logistic regression to assess adjusted odds ratios of different hemoglobin levels across eGFR. Researchers also performed Cox proportional hazards regression to determine adjusted hazard ratios for adverse outcomes across hemoglobin level.
Overall, a correlation was identified between lower eGFR and increased prevalence of anemia. Although 16% of men and 20% of women with anemia had iron studies, low iron results were observed in 60.4% of men and 81.3% of women tested. Across eGFR and hemoglobin level, researchers noticed ESA use was less than 4%.
Analyses revealed that lower hemoglobin independently correlated with increased risk of ESKD, cardiovascular disease, coronary heart disease, stroke, heart failure and death.
“Our study provides generalizable, precise estimates from a large clinical population on the full spectrum of anemia severity. We quantify the association of low eGFR with severe anemia in both men and women. We find that studies to detect iron deficiency are conducted in less than one in five patients with anemia regardless of eGFR level, suggesting a need for greater testing and potentially for iron supplementation,” Farrington and colleagues wrote. They added, “Future studies should investigate safe strategies to mitigate the risks associated with anemia in CKD.”
Collapse
Click Here to Manage Email Alerts