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Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study
BACKGROUND: Routine clinical evidence is limited on clinical outcomes associated with anemia in patients with severe chronic kidney disease (CKD). METHODS: We linked population-based medical databases to identify individuals with severe CKD (eGFR < 30 mL/min/1.73 m(2)) in Northern Denmark from 20...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007417/ https://www.ncbi.nlm.nih.gov/pubmed/31587136 http://dx.doi.org/10.1007/s40620-019-00652-9 |
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author | Toft, Gunnar Heide-Jørgensen, Uffe van Haalen, Heleen James, Glen Hedman, Katarina Birn, Henrik Christiansen, Christian F. Thomsen, Reimar W. |
author_facet | Toft, Gunnar Heide-Jørgensen, Uffe van Haalen, Heleen James, Glen Hedman, Katarina Birn, Henrik Christiansen, Christian F. Thomsen, Reimar W. |
author_sort | Toft, Gunnar |
collection | PubMed |
description | BACKGROUND: Routine clinical evidence is limited on clinical outcomes associated with anemia in patients with severe chronic kidney disease (CKD). METHODS: We linked population-based medical databases to identify individuals with severe CKD (eGFR < 30 mL/min/1.73 m(2)) in Northern Denmark from 2000 to 2016, including prevalent patients as of 1 January 2009 or incident patients hereafter into the study. We classified patients as non-anemic (≥ 12/≥ 13 g/dl hemoglobin (Hgb) in women/men), anemia grade 1 (10–12/13 g/dl Hgb in women/men), 2 (8–10 g/dl Hgb), and 3+ (< 8 g/dl Hgb), allowing persons to contribute with patient profiles and risk time in consecutively more severe anemia grade cohorts. Patients were stratified by dialysis status and followed for clinical outcomes. RESULTS: We identified 16,972 CKD patients contributing with a total of 28,510 anemia patient profiles, of which 3594 had dialysis dependent (DD) and 24,916 had non-dialysis dependent (NDD) severe CKD. Overall, 14% had no anemia, 35% grade 1 anemia, 44% grade 2 anemia and 17% grade 3+ anemia. Compared to patients with no anemia, adjusted hazard ratios (HRs) for NDD patients with grade 3+ anemia were elevated for incident dialysis (1.91, 95% CI 1.61–2.26), any acute hospitalization (1.74, 95% CI 1.57–1.93), all-cause death (1.82, 95% CI 1.70–1.94), and MACE (1.14, 95% CI 1.02–1.26). Similar HRs were observed among DD patients. CONCLUSIONS: Among NDD or DD patients with severe CKD, presence and severity of anemia were associated with increased risks of incident dialysis for NDD patients and with acute hospitalizations, death and MACE for all patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40620-019-00652-9) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-7007417 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-70074172020-02-24 Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study Toft, Gunnar Heide-Jørgensen, Uffe van Haalen, Heleen James, Glen Hedman, Katarina Birn, Henrik Christiansen, Christian F. Thomsen, Reimar W. J Nephrol Original Article BACKGROUND: Routine clinical evidence is limited on clinical outcomes associated with anemia in patients with severe chronic kidney disease (CKD). METHODS: We linked population-based medical databases to identify individuals with severe CKD (eGFR < 30 mL/min/1.73 m(2)) in Northern Denmark from 2000 to 2016, including prevalent patients as of 1 January 2009 or incident patients hereafter into the study. We classified patients as non-anemic (≥ 12/≥ 13 g/dl hemoglobin (Hgb) in women/men), anemia grade 1 (10–12/13 g/dl Hgb in women/men), 2 (8–10 g/dl Hgb), and 3+ (< 8 g/dl Hgb), allowing persons to contribute with patient profiles and risk time in consecutively more severe anemia grade cohorts. Patients were stratified by dialysis status and followed for clinical outcomes. RESULTS: We identified 16,972 CKD patients contributing with a total of 28,510 anemia patient profiles, of which 3594 had dialysis dependent (DD) and 24,916 had non-dialysis dependent (NDD) severe CKD. Overall, 14% had no anemia, 35% grade 1 anemia, 44% grade 2 anemia and 17% grade 3+ anemia. Compared to patients with no anemia, adjusted hazard ratios (HRs) for NDD patients with grade 3+ anemia were elevated for incident dialysis (1.91, 95% CI 1.61–2.26), any acute hospitalization (1.74, 95% CI 1.57–1.93), all-cause death (1.82, 95% CI 1.70–1.94), and MACE (1.14, 95% CI 1.02–1.26). Similar HRs were observed among DD patients. CONCLUSIONS: Among NDD or DD patients with severe CKD, presence and severity of anemia were associated with increased risks of incident dialysis for NDD patients and with acute hospitalizations, death and MACE for all patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40620-019-00652-9) contains supplementary material, which is available to authorized users. Springer International Publishing 2019-10-05 2020 /pmc/articles/PMC7007417/ /pubmed/31587136 http://dx.doi.org/10.1007/s40620-019-00652-9 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Article Toft, Gunnar Heide-Jørgensen, Uffe van Haalen, Heleen James, Glen Hedman, Katarina Birn, Henrik Christiansen, Christian F. Thomsen, Reimar W. Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study |
title | Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study |
title_full | Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study |
title_fullStr | Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study |
title_full_unstemmed | Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study |
title_short | Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study |
title_sort | anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a danish population-based study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007417/ https://www.ncbi.nlm.nih.gov/pubmed/31587136 http://dx.doi.org/10.1007/s40620-019-00652-9 |
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