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Risk of Anemia in Patients with Newly Identified Chronic Kidney Disease - A Population-Based Cohort Study
Søren Viborg Vestergaard1, Uffe Heide-Jørgensen1, Heleen van Haalen2
1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Patients with newly identified chronic kidney disease (CKD) face a high risk of developing anemia, with the risk increasing significantly as CKD progresses. Early awareness and monitoring are crucial for managing this common complication.
Area of Science:
- Nephrology
- Hematology
- Epidemiology
Background:
- Anemia is a common complication in chronic kidney disease (CKD).
- The longitudinal risk of anemia in patients with newly diagnosed CKD remains largely unknown.
- Understanding this risk is crucial for timely intervention and patient management.
Purpose of the Study:
- To investigate the longitudinal risk of developing anemia in patients with newly identified stages 3-5 of chronic kidney disease.
- To quantify the cumulative incidence and hazard ratios of anemia based on CKD stage.
Main Methods:
- A population-based cohort study was conducted using data from Northern Denmark (2009-2016).
- Included were adult patients with newly identified CKD stages 3-5 (eGFR <60 mL/min/1.73m²).
- Anemia risk was calculated using cumulative incidence and Cox regression analyses.
Main Results:
- Over 55,000 individuals with newly identified CKD were analyzed.
- Anemia developed in 42.3% within one year and 67.7% within five years.
- Anemia risk and hazard ratios increased substantially with higher CKD stages, with CKD stage 5 showing a 5.42-fold increased risk compared to stage 3a.
Conclusions:
- Newly identified CKD stages 3-5 are associated with a substantial and progressive risk of anemia.
- The risk of anemia escalates with increasing CKD severity.
- Clinical vigilance for anemia is essential in patients with newly diagnosed or advanced CKD.
Purpose:
Anemia is prevalent in patients with chronic kidney disease (CKD), but the longitudinal risk of anemia in patients with newly identified CKD is unknown. We therefore examined the risks of experiencing anemia in persons with newly identified CKD.
Patients And Methods:
This cohort study included adult patients with newly identified CKD stages 3-5 defined by an estimated glomerular filtration rate (eGFR) level <60 mL/min/1.73m2 (at least two measurements ≥90 days apart) ascertained from a population-based registry with complete laboratory test results in Northern Denmark (population ~2.2 million) during 2009-2016. We calculated 1) cumulative incidence (risk) of anemia [hemoglobin <12/<13 g/dl in women/men] by CKD stage, and 2) adjusted hazard ratios (HRs) of anemia using Cox regression analyses.
Results:
We identified 55,940 distinct individuals with newly identified CKD stages 3-5 and no prevalent anemia [n=41,958 patients in stage 3a, n=17,875 in stage 3b, n=5182 in stage 4, and n=931 in stage 5]. After one year, 42.3% (95%-confidence interval [CI]: 41.9-42.7) of patients with CKD stages 3-5 had newly measured anemia, increasing to 67.7% (95%-CI: 67.2-68.2) after five years. The absolute and relative anemia risk increased markedly with higher CKD stages. The adjusted HR of any anemia was 5.42 (95%-CI: 5.09-5.77) in patients with CKD stage 5 compared to patients with CKD stage 3a.
Conclusion:
Patients with newly identified CKD stages 3-5 have a substantial risk of anemia, increasing with higher CKD stages. This study underlines that clinical awareness of anemia risk is important in patients with newly identified or progressed CKD.
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