Date Published: April 25, 2019
Publisher: Public Library of Science
Author(s): Sang-Wook Yi, Sung Jin Moon, Jee-Jeon Yi, Vivekanand Jha.
The impact of low-normal hemoglobin (Hb) levels and anemia on the risk of end-stage renal disease (ESRD) in general populations has rarely been examined.
510,620 Korean adults aged 40–80 years without known chronic kidney disease (CKD) underwent health examinations during 2002–2003 and were followed-up until 2013. Incidence of ESRD was identified by hospital discharge and clinical visit records.
During a mean follow-up of 10.5, 575 women and 1047 men were diagnosed with ESRD. Lower Hb levels were associated with an increased risk of ESRD at given severity of albuminuria and at given estimated glomerular filtration rate (eGFR). Hb 13–13.9 g/dL in men, Hb 11–11.9 g/dL in women, and trace albuminuria assessed by dipstick urinalysis were associated with more than doubled risk. The risk associated with lower Hb was stronger in older (≥60 years) than younger women. Among 349,993 participants with information on eGFR, the multivariable-adjusted HRs associated with 1 g/dL lower Hb in participants with eGFR values ≥60, 30–59, and <30 mL/min/1.73 m2 were 1.34 (95% CI, 1.17–1.54), 1.55 (1.38–1.74), and 1.75 (1.47–2.09), respectively (Pinteraction between eGFR groups = .06). Low-normal Hb levels and anemia are risk factors for ESRD incidence in person without CKD and for CKD progression to ESRD. Lower Hb increases the risk of ESRD through synergistic biological interactions with lower eGFR and albuminuria. The impacts of lower Hb may be stronger in older than younger women. Proper management and screening at earlier stage of Hb decline and anemia might reduce the burden of CKD.
Approximately 1.2 million people died of chronic kidney disease (CKD) and subsequent end-stage renal disease (ESRD) worldwide in 2015, a 31.7% increase from 2005, and these diseases rose in rank to become the leading cause of premature death from 1990 and 2005 to 2015 . Early detection and primary prevention in high-risk individuals are strategies used to reduce the burden of CKD. However, since most patients are asymptomatic until the advanced stages of CKD, determination of who should be screened and who is at high risk in asymptomatic adults has been a challenge .
Lower Hb levels were consistently associated with an increased risk of ESRD at a given severity of albuminuria and given levels of the eGFR. These results indicated that lower Hb interacts with albuminuria and a lower GFR to increase ESRD. Hb 13–13.9 g/dL in men, Hb 11–11.9 g/dL in women, and trace albuminuria by the dipstick test were associated with a more than doubled risk of ESRD after adjusting for confounders, including the eGFR. Women had stronger associations of low Hb and albuminuria with ESRD incidence than men. The HRs associated with lower Hb became stronger at ages ≥60 years than at ages <60 years in women. Low-normal Hb levels and anemia were risk factors for ESRD incidence in general population without CKD as well as for the progression of CKD to ESRD. Lower Hb had synergic biological interactions with lower eGFR and albuminuria to increase the risk of ESRD incidence. Hb of 13–13.9 g/dL in men, 11–11.9 g/dL in women, and trace albuminuria by dipstick urinalysis were associated with a more than doubled risk of ESRD. The impacts of lower Hb may be stronger in older than younger women. The inclusion of persons with anemia or low-normal Hb in surveillance and management programs for the primary and secondary prevention of CKD may reduce the burden of CKD. Source: http://doi.org/10.1371/journal.pone.0215920