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Kidney Week

Abstract: FR-PO414

Quality-of-Life Penalty Associated with Anemia of CKD in a Large Sample of Dialysis Patients

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis


  • Ion Titapiccolo, Jasmine, Fresenius Medical Care Italia SpA, Palazzo Pignano, Lombardia, Italy
  • Bellocchio, Francesco, Fresenius Medical Care Italia SpA, Palazzo Pignano, Lombardia, Italy
  • Stuard, Stefano, Fresenius Medical Care Italia SpA, Palazzo Pignano, Lombardia, Italy
  • Usvyat, Len A., Fresenius Medical Care, Waltham, Massachusetts, United States
  • Neri, Luca, Fresenius Medical Care Italia SpA, Palazzo Pignano, Lombardia, Italy

Anemia of chronic kidney disease (ACD) is a common complication in dialysis and it is associated with fatigue and weakness, possibly leading to quality of life impairment. Previous reports are old and may not account for recent improvement in renal care. We used the Kidney Disease Quality of Life Short Form (KDQOL-36) questionnaire to assessing the health-related quality of life penalty associated with anemia in a large sample of dialysis patients.


We enrolled 9067 patients from 8 European countries. We assessed the severity of anemia by 5 hemoglobin concentration classes based on the last laboratory assessment available prior to survey administration. We fitted generalized linear models assessing the relationship between each KDQOL-36 subscale and the severity of ACD. We adjusted for age, vintage, gender, country of residence, and comorbidities. We accounted for multicenter design by including a random-intercept parameter. In a secondary analysis we also adjusted for ferritin and inflammatory indexes.


We observed lower KDQOL-36 scores among patients with severe anemia (p < 0.05) (see Table 1). We observed a mild, graded association between mental composite, physical composite and symptoms scale and anemia severity. Despite statistically significant, the Quality of Life penalty associated to ACD was modest and barely clinically significant based on MCID standards. No significant differences were found in the BKD and EKD domains among the anemia groups. By adding ferritin and inflammatory indexes as confounding factors, the significance disappears in all scores.


Anemia of CKD is associated with modest quality of life impairment. Our study suggests that this association may be driven by iron deficiency and inflammation.

 Hb: <8 g/dlHb: 8-10 g/dlHb: 10-12 g/dlHb: >12 g/dl & ESA+Hb: >12 g/dl & ESA-p-value
QOL scoreN=108N=1122N=5164N=1177N=1501 
BKD36.4 (30.6-42.1)38.7 (35.9-41.5)39.3 (37.0-41.7)39.5 (36.8-42.3)39.5 (36.9-42.1)0.76
EKD58.6 (53.1-64.1)63.0 (59.0-67.0)63.8 (59.9-67.6)64.0 (60.0-68.0)64.2 (60.2-68.1)0.06
MCS1241.4 (39.1-43.8)43.8 (42.5-45.1)44.6 (43.5-45.8)44.9 (43.6-46.1)44.7 (43.5-46.0)<0.01
PCS1231.2 (28.0-34.4)33.4 (30.8-35.9)34.6 (32.2-37.1)34.7 (32.1-37.2)34.9 (32.4-37.5)<0.01
SKD71.8 (68.0-75.5)76.2 (73.8-78.6)77.0 (74.8-79.3)77.4 (75.0-79.8)77.3 (74.9-79.7)<0.01

QOL scores mean values in each level of anemia. Mean values are reported with corresponding confidence intervals (CI).