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Abstract: FR-PO391

Anemia Is a Risk Factor for Incident ESRD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression


  • Saraf, Santosh, University of Illinois at Chicago, Chicago, Illinois, United States
  • Hsu, Jesse Yenchih, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Chen, Jing, Tulane School of Medicine, New Orleans, Louisiana, United States
  • Chen, Teresa K., Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
  • Fischer, Michael J., University of Illinois Hospital and Health Sciences Center, Chicago, Illinois, United States
  • Hamm, L. Lee, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • Mehta, Rupal, Northwestern Univesrsity, Feinberg School of Medicine, Chicago, Illinois, United States
  • Sondheimer, James H., Wayne State University School of Medicine, Detroit, Michigan, United States
  • Weir, Matthew R., University of Maryland School of Medicine , Baltimore, Maryland, United States
  • Zhang, Xiaoming, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania, United States
  • Ricardo, Ana C., University of Illinois at Chicago, Chicago, Illinois, United States
  • Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States

Although anemia is a consequence of chronic kidney disease (CKD), anemia itself may accelerate CKD progression. However, the data regarding the impact of anemia on the progression of CKD are inconsistent.


We used Cox proportional hazards to examine the association of baseline anemia (defined using the World Health Organization criteria of hemoglobin [Hgb] <12 g/dL in women and <13 g/dL in men) with incident end-stage renal disease (ESRD) and all-cause death using data from the Chronic Renal Insufficiency Cohort Study.


The study included 3,919 participants with CKD (mean age 58 years, 45% female, 42% white, 42% black, 13% Hispanic, mean estimated glomerular filtration rate (eGFR) 45 ml/min/1.73 m2, and median proteinuria 0.19 g/24h). At study entry, 1,859 (47.4%) of participants had anemia. Compared to individuals without anemia, those with anemia were older, more likely to be black or Hispanic, have lower mean eGFR and more proteinuria (P<0.001 for each). Over a median follow-up of 7.8 years, we observed 1,010 ESRD events and 994 deaths. The table below summarizes the results of our multivariable analyses.


In a large cohort of adults with CKD, anemia was independently associated with increased risk for incident ESRD but not all-cause death. Future work is needed to evaluate the optimal Hgb level for CKD patients.

  Anemia vs. No AnemiaPer 1gm Hgb Decrease
  Hazard Ratio (95% CI)
ESRDModel 1 (a)2.54 (2.22-2.90)1.31 (1.26-1.36)
 Model 2 (b)2.44 (2.13-2.80)1.34 (1.29-1.39)
 Model 3 (c)1.31 (1.13-1.52)1.10 (1.05-1.14)
DeathModel 1 (a)1.64 (1.44-1.86)1.13 (1.09-1.18)
 Model 2 (b)1.43 (1.25-1.63)1.13 (1.09-1.18)
 Model 3 (c)1.03 (0.89-1.19)1.01 (0.97-1.06)

(a) Adjusted for center (b) Further adjusted for age, sex, race/ethnicity, education, income (c) Further adjusted for systolic blood pressure, waist circumference, cardiovascular disease, HgbA1c, phosphate, C-reactive protein, eGFR, proteinuria, ACE-inhibitor/ARB, beta blocker, erythropoiesis stimulating agent


  • Other NIH Support