Research Article: Risk factors for incident anemia of chronic diseases: A cohort study

Date Published: May 6, 2019

Publisher: Public Library of Science

Author(s): Yun-Gyoo Lee, Yoosoo Chang, Jihoon Kang, Dong-Hoe Koo, Seung-Sei Lee, Seungho Ryu, Sukjoong Oh, Gianpaolo Reboldi.


Anemia of chronic disease (ACD) refers to hypoproliferative anemia in the context of acute or chronic activation of the immune system. There is a paucity of prospective data addressing the risk factors for ACD development. An association between common chronic diseases and ACD was examined cross-sectionally and longitudinally.

A cohort of 265,459 healthy participants without ACD at baseline were prospectively followed annually or biennially.

During average follow-up period of 62 months, 4,906 participants developed ACD (incidence rate 3.58 per 1000 person-years). Multivariable-adjusted hazard ratio (HR) [95% confidence interval (CI)] for incident ACD comparing estimated glomerular filtration rate 30–60 and < 30 vs. ≥ 60 ml/min/1.73 m2 were 3.93 [3.18–4.85] and 39.11 [18.50–82.69]; HRs [95% CI] for ACD comparing prediabetes and diabetes vs. normal were 1.19 [1.12–1.27] and 2.46 [2.14–2.84], respectively. HRs [95% CI] for incident ACD comparing body-mass-index (BMI) of < 18.5, 23–24.9 and ≥ 25 vs. 18.5–22.9 kg/m2 were 0.89 [0.78–1.00], 0.89 [0.80–0.99] and 0.78 [0.66–0.91], respectively. HRs [95% CI] for incident ACD comparing prehypertension and hypertension vs. normal were 0.79 [0.73–0.86] and 1.10 [0.99–1.23], respectively. Metabolic syndrome, hypertension, chronic liver disease, and chronic obstructive pulmonary disease were not associated with incident ACD. The severity of chronic kidney disease and diabetic status were independently associated with an increased incidence of ACD, whereas prehypertension and an increasing BMI were significantly associated with decreased risk of ACD.

Partial Text

Anemia of chronic disease (ACD) refers to normochromic, normocytic, hypoproliferative anemia in the context of acute or chronic inflammatory states, including infections, cancers, and autoimmune conditions.[1, 2] Some epidemiological studies have reported that ACD also occurs in clinical conditions accompanied by mild but persistent inflammation including chronic kidney disease (CKD), diabetes mellitus, and aging.[3–5] The prevalence of anemia from most causes has decreased globally between 1990 and 2010, but ACD is expected to increase as population ages.[6–8]

In this large cohort study of young and middle-aged Korean men and women, both the cross-sectional and cohort analyses demonstrated that decreased eGFR and severe diabetic status were associated with increased risk of ACD. Conversely, higher BMI categories were associated with a decreased risk of developing ACD in dose-response manner. These associations persisted even after adjusting for possible confounders. Our results provide information about the relative risk for developing ACD among patients with various common chronic diseases.




Leave a Reply

Your email address will not be published.