Abstract
Chronic kidney disease (CKD) is a public health burden, and anemia is common among patients with CKD. However, less is known regarding the longitudinal association between anemia and deterioration of kidney function among the general population. The China Health and Retirement Longitudinal Study is a nationally representative survey for households with members aged ≥ 45 years. Participants without creatinine and demographic data in 2011 and 2015 were excluded. Anemia was defined according to definitions of the World Health Organization. Rapid decline in kidney function was defined as a ≥16.9% (quartile 3) decline in estimated glomerular filtration rate (eGFR), calculated using the CKD-EPI equation during 2011-2015. Multivariate logistic regression and restricted cubic splines were used to explore their relationship. Altogether, 7210 eligible participants were included in the analysis, with a mean age of 58.6 ± 8.8 years. Rapid decline in kidney function occurred among 1802 (25.0%) participants. Those with kidney function decline were more likely to be older, male, and have anemia, lower eGFRs, hypertension, and cardiovascular disease (P < 0.05). Anemia, or hemoglobin, was independently associated with rapid decline in kidney function after adjusting for potential confounding factors (OR = 1.64, 95% CI, 1.32-2.04; OR = 0.90, 95% CI, 0.87-0.94, respectively). Restricted cubic splines showed a nonlinear relationship between hemoglobin and rapid decline in kidney function, especially for men with anemia (P < 0.05). In conclusion, anemia is an independent risk factor for progression of kidney function among the middle-aged and elderly population. Attentive management and intervention strategies targeting anemia could be effective to reduce the risk of kidney failure and improve the prognosis of the general population.
Highlights
Chronic kidney disease (CKD) is a public health burden globally and has affected 8% to 16% of the world’s population [1, 2]
Lower estimated glomerular filtration rate (eGFR), hypertension, cardiovascular disease (CVD), and anemia were more common in participants with rapid decline in kidney function (P < 0:05)
Our study indicates that anemia is an independent risk factor for the progression of kidney function among the general middle-aged and elderly population, highlighting the importance of specific anemia management in both men and women
Summary
Chronic kidney disease (CKD) is a public health burden globally and has affected 8% to 16% of the world’s population [1, 2]. Patients with CKD are significantly associated with the risk of end-stage kidney disease (ESKD) and other adverse outcomes including lower cognitive abilities, cardiovascular disease (CVD), and death [3, 4]. Anemia is one of the most common complications in patients with CKD, especially in those with lower estimated glomerular filtration rate (eGFR) and those with ESKD requiring kidney replacement therapy [6,7,8]. Anemia is associated with increased cardiovascular risks in patients with CKD [10]
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