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Abstract: PO0277

Association of Anemia with Activities of Daily Living in CKD: The National Health and Nutrition Examination Survey (NHANES), 1999-2016

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism

Authors

  • Michalopoulos, Efstathios N., Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, New Jersey, United States
  • Zhao, Di, Johns Hopkins University, Baltimore, Maryland, United States
  • Farag, Youssef MK, Akebia Therapeutics, Inc., Cambridge, Massachusetts, United States
  • Sanon, Myrlene, Otsuka Pharmaceutical Development and Commercialization, Inc., Princeton, New Jersey, United States
  • Finkelstein, Fredric O., Yale University, New Haven, Connecticut, United States
Background

Anemia is a major contributor to clinical burden and may negatively impact patient outcomes in chronic kidney disease (CKD). We assessed the impact of anemia on activities of daily living (ADLs) among participants with CKD in the US population.

Methods

A cross-sectional study (n=33,300; aged ≥20 years) using NHANES data (1999-2016) was conducted. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula. Participants were classified as no CKD, CKD stage 1-2, and CKD stage 3-5 using KDIGO criteria. Anemia was defined using WHO criteria. ADL impairment was defined as “some difficulty” or worse in ≥1 activity (19 items).

Results

Mean age of participants was 46.7 years; 51.0% were female. The percentage of participants with no CKD, CKD stage 1-2, and CKD stage 3-5 was 86.4%, 7.6%, and 6.0%, respectively. Anemia prevalence in each CKD category was 4.9%, 8.7%, and 18.6%, respectively. Multivariable-adjusted prevalence of impairment in ≥1 ADL, by CKD and anemia status, is presented along with covariates in the Table. Compared to participants with no anemia, the adjusted prevalence ratio for impairment in ≥1 ADL was 1.06 (95%CI: 0.98-1.14; p=0.13) in no CKD, 1.14 (0.99-1.28; p=0.06) in CKD stage 1-2, and 1.20 (1.05-1.35; p=0.01) in CKD stage 3-5.

Conclusion

In a large representative sample of US adults, anemia was significantly associated with an increased prevalence of impaired ADLs in subjects who are CKD stage 3-5. The clinical implications of this association should be investigated further.

Adjusted prevalence (95%CI) of impairment in ≥1 ADL, by CKD and anemia category
 No CKDCKD stage 1-2CKD stage 3-5
No anemia30.9 (24.3, 37.5)32.7 (26.4, 39.1)33.5 (27.0, 40.0)
Anemia32.7 (25.8, 39.6)37.3 (29.9, 44.7)40.2 (32.9, 47.4)
p-value0.130.060.01

Table reports percentages. Marginally-adjusted prevalence derived using logistic regression models (age, sex, race, education, marital status, income, health insurance, employment, smoking, alcohol use, congestive heart failure, coronary heart disease, angina pectoris, heart attack, stroke, arthritis, chronic obstructive pulmonary disease, body mass index, hypertension, diabetes, and hyperlipidemia). P-values compare anemia vs. no anemia.

Funding

  • Commercial Support