Kidney Week

Abstract: FR-PO0542

Anemia and Incident Cardiovascular Events in Patients with CKD

Session Information

• CKM: Clinical - Trials, Epidemiology, and Biomarkers
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Zaidan, Nadim, Staten Island University Hospital, New York, New York, United States

Nadim Zaidan, MD

• Saperstein, Yiela, Staten Island University Hospital, New York, New York, United States

Yiela Saperstein, MD, MS

• Bou Sanayeh, Elie, Staten Island University Hospital, New York, New York, United States

Elie Bou Sanayeh, MD, MBA

• Coppa, Kevin, Northwell Health, New Hyde Park, New York, United States

Kevin Coppa, MS

• Chung, Paul J., Northwell Health, New Hyde Park, New York, United States

Paul J. Chung, MD

• El Sayegh, Suzanne E., Staten Island University Hospital, New York, New York, United States

Suzanne E. El Sayegh, MD, FASN

• Bonifant, George C., Staten Island University Hospital, New York, New York, United States

George C. Bonifant, MD, FASN

Background

Cardiovascular (CV) diseases are the leading cause of mortality in chronic kidney disease (CKD). The excess CV risk in CKD has an inverse relationship with estimated glomerular filtration rate (eGFR) and cannot be fully attributed to traditional metabolic risk factors. In patients with stage 3 CKD, we investigated the impact of hemoglobin levels on incident cardiovascular outcomes.

Methods

We conducted a retrospective cohort study including patients with eGFR between 30-60 mL/min/1.73 m2 from Northwell Health outpatient clinics between 2018-2019. Patients with established CVD at baseline were excluded. Patients were followed through 2024 for incident CV events, ascertained through newly documented ICD-10 codes relative to: (1) atherosclerotic CVD (2) arrhythmias and (3) heart failure (HF). Hemoglobin quartiles were the exposure of interest. Three sequential multivariate binary logistic regressions were performed: Model 1 adjusted for age, sex and baseline eGFR; Model 2 also accounted for hypertension, diabetes mellitus, and dyslipidemia status; Model 3 further adjusted for baseline use of antiplatelets, statins, SGLT2i, GLP1Ra, ACEi/ARB and MRA. A similar analysis was conducted for ferritin levels. Statistical significance of the model by Likelihood Ratio Test was defined as p-value <0.05 and multiple comparison testing accounted for by Benjamini-Hochberg. Analyses were conducted using R 4.3.3.

Results

Baseline hemoglobin and ferritin values were available for 20,212 and 1,969 respectively, out of 27,909 CKD patients meeting inclusion and exclusion criteria. Compared to the 1st quartile (median hemoglobin 11 g/dL), the 2nd, 3rd and 4th quartiles (median hemoglobin 12.6, 13.7, 15 respectively) had progressively lower odds of incident HF across the 3 models (For Model 3: Q2 Odds Ratio with 95% CI: 0.87 [0.77-0.98] , Q3 0.62 [0.54-0.71], Q4 0.58 [0.5-0.68]). Higher hemoglobin levels were significantly associated with higher odds of arrhythmia, but not with incident atherosclerotic CVD. Interestingly, ferritin levels were not associated with any CV outcome, suggesting that the observed association may be partially independent of iron stores.

Conclusion

These findings underscore the need to elucidate the pathophysiological mechanisms underlying the development of CV disease in CKD to facilitate development of therapeutic strategies targeting these CKD-specific maladaptive pathways.

Acknowledgment

This study was supported by the REACH Award, funded by Bayer, the National Kidney Foundation and Women in Nephrology.

Funding

• Commercial Support – Bayer