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Abstract: PO2070

A Marginal Structural Model to Estimate Causal Effect of Time-Dependent Anemia Status on Renal and Cardiovascular Outcomes Among Community-Dwelling Japanese Subjects at Beginning of Impaired Renal Function

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention


  • Onozawa, Satoshi, Astellas Pharma, Inc., Tokyo, Japan
  • Kimura, Tomomi, Astellas Pharma, Inc., Northbrook, Illinois, United States
  • Morita, Masataka, Astellas Pharma, Inc., Tokyo, Japan
  • Yamamoto, Osamu, Astellas Pharma, Inc., Tokyo, Japan
  • Akizawa, Tadao, Showa University School of Medicine, Tokyo, Japan

We investigated whether anemia increases the risk of renal and cardiovascular (CV) outcomes considering the changes of anemic status over time, using a marginal structural model.


We retrospectively analyzed data from a Japanese database (JMDC) consists of annual health checkup data linked to medical and pharmacy claims for over 3 million of beneficiaries. Subjects with consequent eGFR values of ≥60 and then <60 mL/min/1.73 m2 within 2 years and during the period between 2008 and 2019 were included. The first date where the eGFR value became <60 was defined as the index date. Patients without serum creatinine (SCr) record within 38 months from the index date were excluded. Anemia status (yes/no) was defined by the age-sex specific hemoglobin value according to the Japanese guidelines. Renal outcomes (composite of ≥30% eGFR decline over 3 years, eGFR <15 ml/min/1.73m2, SCr doubling, initiation of chronic dialysis and kidney transplantation), CV outcomes (myocardial infarction, stroke, unstable angina and heart failure) and mortality was assessed. In order to incorporate dynamic change of anemia status and covariates during the follow-up, a time-dependent standardized inverse probability weight at time x was estimated based on propensity score to either be—or not be—anemia at time x. Weighted survival probability and weighted hazard ratio were estimated.


32,870 subjects were enrolled in the study cohort (median age 52, 73% male) and 4.2% of subjects had anemia at the baseline. Anemia treatment was rarely provided even in the anemia group (3.9%). During the average of 4.1-year of follow-up period, 210 renal outcomes and 1039 CV outcomes occurred. In 91% of the cases with the renal outcomes, eGFR decline occurred first. The weighted hazard ratios (95% confidence intervals) for renal outcomes, CV outcomes and mortality were 2.6 (1.7-3.8), 1.6 (1.2-2.2), and 2.8 (1.8-4.3), respectively.


Anemia was an independent risk for eGFR decline, CV events and mortality in these Japanese community-dwelling subjects at the very beginning of renal impairment, considering the time-dependent nature of anemia status.


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