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Low hemoglobin, chronic kidney disease, and risk for coronary heart disease-related death: the Blue Mountains Eye
Stephen R Leeder1, Paul Mitchell, Gerald Liew
1The Australian Health Policy Institute, College of Health Sciences, University of Sydney, Westmead Hospital, Hawkesbury Road, Westmead, NSW Australia, 2145.
Insights
Chronic kidney disease (CKD) combined with low hemoglobin, even within normal ranges, significantly elevates the risk of coronary heart disease (CHD) death. This increased risk was not observed in individuals without CKD.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Previous research indicated a link between chronic kidney disease (CKD) and increased coronary heart disease (CHD) risk, particularly in individuals with anemia.
- The Blue Mountains Eye Study cohort provided an opportunity to prospectively investigate this association in an Australian population.
Purpose of the Study:
- To verify the hypothesis that CKD exacerbates CHD risk specifically in individuals with low hemoglobin levels.
- To examine the interaction between estimated glomerular filtration rate (eGFR) and hemoglobin levels concerning CHD-related mortality.
Main Methods:
- A prospective cohort study of 3654 Australian adults aged 49-97 years.
- Fasting blood samples were collected, and CHD-related deaths were tracked over 9 years using the Australian National Death Index.
- CKD was defined as eGFR <60 ml/min/1.73 m² (Cockcroft-Gault equation), and low hemoglobin was defined as levels in the lowest quintile.
Main Results:
- Individuals with CKD and low hemoglobin exhibited a significantly increased risk of CHD-related death (HR 1.49; 95% CI 1.08-2.06) compared to those with CKD and higher hemoglobin.
- This heightened risk associated with low hemoglobin was specific to the CKD group and not observed in individuals without CKD.
- A significant interaction between eGFR and hemoglobin was found when using the Cockcroft-Gault or Bjornsson equations for eGFR estimation.
Conclusions:
- The presence of CKD, particularly when accompanied by low hemoglobin levels (even within the normal range), is associated with an elevated risk of CHD-related mortality.
- These findings underscore the importance of considering hemoglobin status in the cardiovascular risk assessment of patients with CKD.
Abstract:
A recent report found that chronic kidney disease (CKD) increased the risk for coronary heart disease (CHD) events in people with anemia but not in those without anemia. This study aimed to verify these findings in the Blue Mountains Eye Study cohort, a prospective Australian population-based study of 3654 residents aged 49 to 97 yr. Fasting blood samples were obtained at baseline and confirmed CHD-related deaths over 9 yr with the Australian National Death Index. "Low hemoglobin" was defined as levels in the lowest quintile of the cohort. Body surface area-adjusted GFR was estimated using a variety of methods (Cockcroft-Gault, abbreviated Modification of Diet in Renal Disease, and Bjornsson equations). People with CKD (GFR <60 ml/min per 1.73 m2 as estimated using the Cockcroft-Gault equation) and low hemoglobin (mean 13.2 g/dl; range 7.6 to 14.6 g/dl) had an increased risk for CHD-related death (multivariable-adjusted hazard risk ratio 1.49; 95% confidence interval 1.08 to 2.06) compared with people with CKD but in higher hemoglobin quintiles. This effect was not evident in people without CKD. The interaction between GFR and hemoglobin was significant (P = 0.05) when GFR was estimated using either the Cockcroft-Gault or Bjornsson equations or when serum creatinine instead of GFR was used in the analyses but not when GFR was estimated using the abbreviated Modification of Diet in Renal Disease equation. In conclusion, this study found that low hemoglobin, even within the normal range, together with CKD increased the risk for CHD-related death.
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