Kidney Week

Abstract: SA-PO243

A Rapid Decline of Residual Kidney Function and Anemia in Hemodialysis Patients

Session Information

• Anemia and Iron Metabolism: Clinical
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Anemia and Iron Metabolism

• 202 Anemia and Iron Metabolism: Clinical

Authors

• Kimura, Hiroshi, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Hiroshi Kimura,

• Okuda, Yusuke, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, United States

Yusuke Okuda,

• Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Connie Rhee,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Elani Streja,

• Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Kamyar Kalantar-Zadeh,

Background

Patients on dialysis commonly develop anemia due to the kidney’s critical role in red blood cell production. Slower residual kidney function (RKF) decline on dialysis is associated with better outcomes. We hypothesized that a faster decline in RKF may be associated with a higher odds of developing anemia in the incident hemodialysis (HD) patients.

Methods

The associations of decline in RKF with anemia were examined retrospectively across four strata of annual change in RKF (residual renal urea clearance [KRU], <-3.0, -3.0 to <-1.5, -1.5 to <0, ≥0 mL/min/1.73m²; urinary volume, <-600, -600 to <-300, -300 to <0, ≥0 mL/day) using logistic regression models adjusted for clinical characteristics and laboratory variables in 5,403 incident HD patients of a large US dialysis organization between January 1, 2007 and December 31, 2011.

Results

A total of 5,291 (98%) patients used erythropoiesis-stimulating agents (ESAs) during the first year of HD initiation. The median baseline values of the annual change in KRU and urinary volume were -1.2 (interquartile range [IQR]: -2.8 to 0.1) mL/min/1.73m² and -250 (IQR: -600 to 100) mL/day, respectively. Multivariate logistic regression models revealed that the fastest RKF decline in the first year of HD was associated with higher odds of anemia (Figure). These associations remained robust against adjustment for laboratory variables and consistent across strata of baseline RKF, age, sex, race, diabetes, congestive heart failure, hemoglobin, and serum albumin. Analyses using urinary volume as another index of RKF showed consistent associations.

Conclusion

Rapid RKF decline during the first year of dialysis was associated with anemia among incident HD patients.

Funding

• NIDDK Support