Albuminuria as a Risk Factor for Anemia in Chronic Kidney Disease: Result from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD)

Ji Suk Han; Mi Jung Lee; Kyoung Sook Park; Seung Hyeok Han; Tae-Hyun Yoo; Kook-Hwan Oh; Sue Kyung Park; Joongyub Lee; Young Youl Hyun; Wookyung Chung; Yeong Hoon Kim; Curie Ahn; Kyu Hun Choi

doi:10.1371/journal.pone.0139747

Albuminuria as a Risk Factor for Anemia in Chronic Kidney Disease: Result from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD)

PLoS One. 2015 Oct 2;10(10):e0139747. doi: 10.1371/journal.pone.0139747. eCollection 2015.

Authors

Affiliations

¹ Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
² Department of Internal Medicine, Seoul National University, Seoul, Korea.
³ Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
⁴ Medical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea.
⁵ Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University, Seoul, Korea.
⁶ Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, Korea.
⁷ Department of Internal Medicine, Inje University, Pusan Paik Hospital, Busan, Korea.

Abstract

Background: Anemia is a common complication among patients with chronic kidney disease (CKD), and it is associated with unfavorable clinical outcomes in patients with CKD independent of the estimated glomerular filtration rate (eGFR). We assessed the association of the urinary albumin-to-creatinine ratio (ACR) and eGFR with anemia in CKD patients.

Methods: We conducted a cross-sectional study using baseline data from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD). Multiple regression analysis was performed to identify the independent association of albuminuria with anemia. Furthermore, odds ratios for anemia were calculated by cross-categorization of ACR and eGFR.

Results: Among 1,456 patients, the mean age was 53.5 ± 12.4 years, and the mean eGFR and ACR were 51.9 ± 30.5 mL/min per 1.73 m2 and 853.2 ± 1,330.3 mg/g, respectively. Anemia was present in 644 patients (40.5%). Multivariate analysis showed that the odds ratio of anemia increased according to ACR levels, after adjusting for age, sex, eGFR, body mass index, pulse pressure, cause of CKD, use of erythropoiesis stimulating agents, serum calcium and ferritin (ACR < 30 mg/g as a reference group; 30-299 mg/g, adjusted odds ratio (OR) = 1.43, 95% confidence interval (CI) = 0.88-2.33; ≥300 mg/g, adjusted OR = 1.86, 95% CI = 1.12-3.10). In addition, graded associations were observed in cross-categorized groups of a higher ACR and eGFR compared to the reference group with an ACR <30 mg/g and eGFR ≥60 mL/min per 1.73 m2.

Conclusion: The present study demonstrated that albuminuria was a significant risk factor for anemia in CKD patients independent of the eGFR.

Trial registration: ClinicalTrials.gov NCT01630486.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Albuminuria / complications*
Anemia / complications*
Cohort Studies
Humans
Kidney Failure, Chronic / complications*
Middle Aged
Republic of Korea
Risk Factors
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01630486

Grants and funding

This study was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention (2011-2013-E33016-02#). The study is supervised by the CKD Advisory Committee composed of the members from the KCDC and the Korean Society of Nephrology (KSN, NCT01630486 at http://www.clinicaltrials.gov). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.