Teresa K Chen1, Michelle M Estrella2, Brad C Astor3, Tom Greene4, Xuelei Wang5, Morgan E Grams2, Lawrence J Appel6. 1. Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 2. Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA. 3. Division of Nephrology, University of Wisconsin School of Medicine, Madison, WI, USA. 4. Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA. 5. Center for Clinical Investigation, Case Western Reserve University School of Medicine, Cleveland, OH, USA. 6. Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
Abstract
BACKGROUND:Anemia is common in chronic kidney disease (CKD) and associated with poor outcomes. In cross-sectional studies, lower estimated glomerular filtration rate (eGFR) has been associated with increased risk for anemia. The aim of this study was to determine how hematocrit changes as eGFR declines and what factors impact this longitudinal association. METHODS: We followed 1094 African-Americans with hypertensive nephropathy who participated in the African-American Study of Kidney Disease and Hypertension. Mixed effects models were used to determine longitudinal change in hematocrit as a function of eGFR. Interaction terms were used to assess for differential effects of age, gender, baseline eGFR, baseline proteinuria, malnutrition and inflammation on eGFR-associated declines in hematocrit. In sensitivity analyses, models were run using iGFR (by renal clearance of I(125) iothalamate) in place of eGFR. RESULTS: At baseline, mean hematocrit was 39% and 441 (40%) individuals had anemia. The longitudinal relationship between eGFR and hematocrit differed by baseline eGFR and was steeper when baseline eGFR was <45 mL/min/1.73 m(2). For example, the absolute decline in hematocrit per 10 mL/min/1.73 m(2) decline in longitudinal eGFR was -3.7, -1.3 and -0.5% for baseline eGFR values of 20, 40 and 60 mL/min/1.73 m(2), respectively (P < 0.001 comparing the longitudinal association between baseline eGFR = 40 or 60 versus baseline eGFR = 20 mL/min/1.73 m(2)). Similarly, male sex, younger age (<65 years) and higher baseline proteinuria (protein-to-creatinine ratio >0.22) were associated with greater hematocrit declines per unit decrease in longitudinal eGFR compared with female sex, older age and low baseline proteinuria, respectively (P-interaction <0.05 for each comparison). The longitudinal eGFR-hematocrit association did not differ by body mass index, serum albumin or C-reactive protein. CONCLUSIONS: Men, younger individuals and those with low baseline eGFR (<45 mL/min/1.73 m(2)) or baseline proteinuria are particularly at risk for eGFR-related declines in hematocrit.
RCT Entities:
BACKGROUND:Anemia is common in chronic kidney disease (CKD) and associated with poor outcomes. In cross-sectional studies, lower estimated glomerular filtration rate (eGFR) has been associated with increased risk for anemia. The aim of this study was to determine how hematocrit changes as eGFR declines and what factors impact this longitudinal association. METHODS: We followed 1094 African-Americans with hypertensive nephropathy who participated in the African-American Study of Kidney Disease and Hypertension. Mixed effects models were used to determine longitudinal change in hematocrit as a function of eGFR. Interaction terms were used to assess for differential effects of age, gender, baseline eGFR, baseline proteinuria, malnutrition and inflammation on eGFR-associated declines in hematocrit. In sensitivity analyses, models were run using iGFR (by renal clearance of I(125) iothalamate) in place of eGFR. RESULTS: At baseline, mean hematocrit was 39% and 441 (40%) individuals had anemia. The longitudinal relationship between eGFR and hematocrit differed by baseline eGFR and was steeper when baseline eGFR was <45 mL/min/1.73 m(2). For example, the absolute decline in hematocrit per 10 mL/min/1.73 m(2) decline in longitudinal eGFR was -3.7, -1.3 and -0.5% for baseline eGFR values of 20, 40 and 60 mL/min/1.73 m(2), respectively (P < 0.001 comparing the longitudinal association between baseline eGFR = 40 or 60 versus baseline eGFR = 20 mL/min/1.73 m(2)). Similarly, male sex, younger age (<65 years) and higher baseline proteinuria (protein-to-creatinine ratio >0.22) were associated with greater hematocrit declines per unit decrease in longitudinal eGFR compared with female sex, older age and low baseline proteinuria, respectively (P-interaction <0.05 for each comparison). The longitudinal eGFR-hematocrit association did not differ by body mass index, serum albumin or C-reactive protein. CONCLUSIONS:Men, younger individuals and those with low baseline eGFR (<45 mL/min/1.73 m(2)) or baseline proteinuria are particularly at risk for eGFR-related declines in hematocrit.
Authors: Jackson T Wright; George Bakris; Tom Greene; Larry Y Agodoa; Lawrence J Appel; Jeanne Charleston; DeAnna Cheek; Janice G Douglas-Baltimore; Jennifer Gassman; Richard Glassock; Lee Hebert; Kenneth Jamerson; Julia Lewis; Robert A Phillips; Robert D Toto; John P Middleton; Stephen G Rostand Journal: JAMA Date: 2002-11-20 Impact factor: 56.272
Authors: J Lewis; L Agodoa; D Cheek; T Greene; J Middleton; D O'Connor; A Ojo; R Phillips; M Sika; J Wright Journal: Am J Kidney Dis Date: 2001-10 Impact factor: 8.860
Authors: William McClellan; Stephen L Aronoff; W Kline Bolton; Sally Hood; Daniel L Lorber; K Linda Tang; Thomas F Tse; Brian Wasserman; Marc Leiserowitz Journal: Curr Med Res Opin Date: 2004-09 Impact factor: 2.580
Authors: Jennifer J Gassman; Tom Greene; Jackson T Wright; Lawrence Agodoa; George Bakris; Gerald J Beck; Janice Douglas; Ken Jamerson; Julia Lewis; Michael Kutner; Otelio S Randall; Shin-Ru Wang Journal: J Am Soc Nephrol Date: 2003-07 Impact factor: 10.121
Authors: Lawrence J Appel; John Middleton; Edgar R Miller; Michael Lipkowitz; Keith Norris; Lawrence Y Agodoa; George Bakris; Janice G Douglas; Jeanne Charleston; Jennifer Gassman; Tom Greene; Kenneth Jamerson; John W Kusek; Julia A Lewis; Robert A Phillips; Stephen G Rostand; Jackson T Wright Journal: J Am Soc Nephrol Date: 2003-07 Impact factor: 10.121
Authors: José Portolés; Jose Luis Gorriz; Esther Rubio; Fernando de Alvaro; Florencio García; Vicente Alvarez-Chivas; Pedro Aranda; Alberto Martinez-Castelao Journal: BMC Nephrol Date: 2013-01-07 Impact factor: 2.388
Authors: Stein I Hallan; Kunihiro Matsushita; Yingying Sang; Bakhtawar K Mahmoodi; Corri Black; Areef Ishani; Nanne Kleefstra; David Naimark; Paul Roderick; Marcello Tonelli; Jack F M Wetzels; Brad C Astor; Ron T Gansevoort; Adeera Levin; Chi-Pang Wen; Josef Coresh Journal: JAMA Date: 2012-12-12 Impact factor: 56.272
Authors: Rupal Mehta; Xuan Cai; Alexander Hodakowski; Jungwha Lee; Mary Leonard; Ana Ricardo; Jing Chen; Lee Hamm; James Sondheimer; Mirela Dobre; Valentin David; Wei Yang; Alan Go; John W Kusek; Harold Feldman; Myles Wolf; Tamara Isakova Journal: Clin J Am Soc Nephrol Date: 2017-08-07 Impact factor: 8.237
Authors: Santosh L Saraf; Jesse Y Hsu; Ana C Ricardo; Rupal Mehta; Jing Chen; Teresa K Chen; Michael J Fischer; Lee Hamm; James Sondheimer; Matthew R Weir; Xiaoming Zhang; Myles Wolf; James P Lash Journal: Kidney360 Date: 2020-07-30