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Abstract: TH-PO260

Reduced Hemoglobin Level Increases Risk of Incident Heart Failure and Atherosclerotic Events in CKD: The CRIC Study

Session Information

Category: Anemia and Iron Metabolism

  • 202 Anemia and Iron Metabolism: Clinical


  • Saraf, Santosh, University of Illinois at Chicago, Chicago, Illinois, United States
  • Hsu, Jesse Yenchih, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Ricardo, Ana C., University of Illinois at Chicago, Chicago, Illinois, United States
  • Kansal, Mayank, University of Illinois at Chicago, Chicago, Illinois, United States
  • Chen, Jing, Tulane School of Medicine, New Orleans, Louisiana, United States
  • Fischer, Michael J., University of Illinois Hospital and Health Sciences Center, Chicago, Illinois, United States
  • He, Jiang, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Mehta, Rupal, Northwestern Univesrsity, Feinberg School of Medicine, Chicago, Illinois, United States
  • Tan, Thida C., Kaiser Permanente Northern California, Oakland, California, United States
  • Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
  • Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States

Group or Team Name

  • On behalf of the CRIC investigators

Anemia may exacerbate cardiac ischemia or contribute to abnormal left ventricular remodeling but data regarding the impact of anemia on cardiovascular outcomes in chronic kidney disease (CKD) have been inconsistent.


We used Cox proportional hazards to examine the association of hemoglobin (Hgb) level (per 1 gm decrease) with incident heart failure, atherosclerotic events (myocardial infarction, stroke, or peripheral artery disease), and all-cause death among participants with CKD in the Chronic Renal Insufficiency Cohort Study.


Among 3,919 participants with CKD (mean age 58 yrs, 45% women, 42% white, 42% black, 13% Hispanic, mean eGFR 45 ml/min/1.73 m2, median proteinuria 0.19 g/24h, and mean entry Hgb 12.6±1.8), 1,859 (47.4%) participants had anemia (defined using WHO criteria of Hgb <12 g/dL in women and <13 g/dL in men) at study entry. Compared to individuals without anemia, those with anemia were older, more likely to be black or Hispanic, have prior clinical cardiovascular disease, and had a lower mean eGFR at baseline. Over a median follow-up of 8.8 years, we observed 757 heart failure events, 692 atherosclerotic events, and 1148 deaths. In multivariable analyses, lower Hgb was associated with significantly higher rates of heart failure and atherosclerotic events that may be partially explained by subclinical cardiac ischemia.


In a large, diverse CKD cohort, lower Hgb was independently associated with an increased risk for heart failure and atherosclerotic events.

 Heart FailureAtheroscleroticAll Cause Death
 Hazard Ratio (95% CI)
Per 1gm decrease in Hgb concentration
Model 1 (a)1.25 (1.19-1.31)1.18 (1.13-1.24)1.15 (1.11-1.20)
Model 2 (b)1.12 (1.06-1.18)1.10 (1.04-1.16)1.03 (0.99-1.08)
Model 3 (c)1.12 (1.06-1.18)1.10 (1.04-1.16)1.04 (1.00-1.09)
Model 4 (d)1.09 (1.04-1.15)1.08 (1.02-1.14)1.01 (0.97-1.05)

(a) Adjusted for center, age, sex, race/ethnicity, education, income (b) Model 1 + cardiovascular disease, systolic BP, HgbA1c, smoking, LDL, eGFR, urine protein, ACE-inhibitor/ARB, aspirin/anti-platelet, statin, erythrocyte stimulating agent (c) Model 2 plus LVH by ECG (d) Model 2 plus troponin I.


  • Other NIH Support