Severe CKD: anemia presence, severity predict risk for incident dialysis

  • Toft G & al.
  • J Nephrol
  • 5 Oct 2019

  • International Clinical Digest
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Takeaway

  • Anemia presence and severity are tied to increased risks for incident dialysis in patients with non-dialysis dependent (NDD) severe chronic kidney disease (CKD).
  • Data also showed higher risks for acute hospitalization, death, and major adverse cardiovascular events (MACE).

Why this matters

  • Current clinical practice guidelines focus on less-intensive anemia therapy in this setting.

Study design

  • Danish population study of 16,972 unique patients with severe CKD (estimated glomerular filtration rate 2) contributing 28,510 anemia patient profiles.
  • Most cases of anemia (87.4%) occurred in NDD-CKD.
  • Funding: AstraZeneca.  

Key results

  • Anemia status:
    • No anemia, 14%.
    • Grade 1 anemia, 35% (hemoglobin [Hg] 10-12/13 g/dL in women/men).
    • Grade 2 anemia, 44% (8-10 g/dL).
    • Grade 3+ anemia, 17% (
  • NDD-CKD: all risks rose with anemia severity. With presence of grade 3+ vs no anemia (aHR, 95% CI):
    • Incident dialysis: 1.91 (1.61-2.26).
    • Acute hospitalization: 1.74 (1.57-1.93).
    • All-cause mortality: 1.82 (1.70-1.94).
    • MACE: 1.14 (1.02-1.26), particularly heart failure (aHR=1.24; 95% CI, 1.09-1.41).
  • A similar pattern emerged in dialysis-dependent patients. With grade 3+ vs no anemia (aHR, 95% CI):
    • Acute hospitalization: 1.51 (1.20-1.90).
    • All-cause mortality: 1.91 (1.50-2.43).
    • Finding for MACE limited by patient number.
  • Effect was not significantly modified by age or diabetes.

Limitations

  • Observational design.
  • Potential testing bias.

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