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Abstract: TH-PO261

Association of Anemia with Clinical Outcomes in Patients with Severe CKD: A Danish Population-Based Study

Session Information

Category: Anemia and Iron Metabolism

  • 202 Anemia and Iron Metabolism: Clinical

Authors

  • Thomsen, Reimar W., Aarhus University Hospital, Aarhus, Denmark
  • Heide-Jørgensen, Uffe, Aarhus University Hospital, Aarhus, Denmark
  • Toft, Gunnar, Aarhus University Hospital, Aarhus, Denmark
  • Sinsakul, Marvin, AstraZeneca, Gothenburg, Sweden
  • van Haalen, Heleen, AstraZeneca, Gothenburg, Sweden
  • Pedersen, Lars, Aarhus University Hospital, Aarhus, Denmark
  • Sorensen, Henrik Toft, Aarhus University Hospital, Aarhus, Denmark
Background

Real-world evidence is limited on clinical outcomes associated with anemia in patients with chronic kidney disease (CKD). We investigated the association of anemia with incident dialysis, adverse cardiovascular (CV) outcomes and death in patients with severe CKD.

Methods

We linked laboratory and healthcare databases to identify individuals with stage 4 or 5 CKD (eGFR <30) in Northern Denmark on 1 Jan 2012. We classified patients by anemia grade using lowest hemoglobin (Hb) value in 2011 (grade 1: Hb 10 to <12/<13 g/dL; grade 2+: Hb <10 g/dL). Patients were stratified by dialysis status on 1 Jan 2012 and followed for incident dialysis, first CV event (myocardial infarction, stroke, and heart failure hospitalization) and all-cause death. We computed incidence rates and derived risk curves and adjusted hazard ratios (HRs) through cumulative incidence function and Cox proportional hazards regression.

Results

Of 4,120 patients with severe CKD (median age 77 years), 45% had no anemia, 41% had grade 1 anemia, and 14% had grade 2+ anemia. Incidence rates for dialysis, CV events and death increased with increasing anemia severity (Table). After controlling for baseline differences in age, gender, CV history, other comorbidities, eGFR level and CKD duration, HRs for incident dialysis were increased for patients with grade 1 and particularly with grade 2+ anemia. Moreover, HRs for CV events and death were elevated among both non-dialysis and dialysis patients. A similar risk pattern for CV events and death was observed when non-dialysis patients were censored at dialysis initiation.

Conclusion

In routine clinical care patients with severe CKD, the presence and severity of anemia was associated with increased risks of incident dialysis, CV events and death.

 Incident dialysisCardiovascular eventAll-cause death
Dialysis status at index dateAnemia gradeIncidence rate per 100 person-years (95% CI)Adjusted
hazard ratio
(95% CI)
Incidence rate per 100 person-years (95% CI)Adjusted
hazard ratio
(95% CI)
Incidence rate per 100 person-years (95% CI)Adjusted
hazard ratio
(95% CI)
Non-dialysisNo anemia1.6 (1.3 - 2.0)Ref.7.1 (6.4 - 7.8)Ref.10.5 (9.7 - 11.3)Ref.
Anemia grade 13.4 (2.9 - 4.0)1.33 (1.03 - 1.70)9.7 (8.9 - 10.7)1.28 (1.12 - 1.46)14.6 (13.6 - 15.6)1.28 (1.15 - 1.42)
Anemia grade 2+4.6 (3.4 - 6.1)1.41 (0.98 - 2.03)11.2 (9.3 - 13.5)1.38 (1.11 - 1.70)20.7 (18.2 - 23.5)1.79 (1.54 - 2.07)
DialysisNo anemiaN/AN/A6.4 (3.9 - 9.8)Ref.6.4 (4.0 - 9.6)Ref.
Anemia grade 1N/AN/A10.7 (7.9 - 14.2)1.40 (0.79 - 2.48)13.8 (10.8 - 17.3)2.15 (1.31 - 3.54)
Anemia grade 2+N/AN/A13.0 (10.0 - 16.7)1.74 (0.96 - 3.14)18.3 (15.1 - 22.1)3.30 (2.00 - 5.42)

Funding

  • Commercial Support