PMID- 35664282 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220716 IS - 2048-8505 (Print) IS - 2048-8513 (Electronic) IS - 2048-8505 (Linking) VI - 15 IP - 6 DP - 2022 Jun TI - New-onset anemia and associated risk of ESKD and death in non-dialysis CKD patients: a multicohort observational study. PG - 1120-1128 LID - 10.1093/ckj/sfac004 [doi] AB - BACKGROUND: Anemia is a common complication of chronic kidney disease (CKD), but its incidence in nephrology settings is poorly investigated. Similarly, the risks of adverse outcomes associated with new-onset anemia are not known. METHODS: We performed a pooled analysis of three observational cohort studies including 1031 non-anemic CKD patients with eGFR <60 mL/min/1.73 m(2) regularly followed in renal clinics. We estimated the incidence of mild anemia (hemoglobin 11-12 g/dL in women and 11-13 g/dL in men) and severe anemia (hemoglobin <11 g/dL or use of erythropoiesis-stimulating agents) during a 3-year follow-up period. Thereafter we estimated the risk of end-stage kidney disease (ESKD) and all-cause death associated with new-onset mild and severe anemia. RESULTS: The mean age was 63 +/- 14 years, 60% were men and 20% had diabetes. The mean estimated glomerular filtration rate (eGFR) was 37 +/- 13 mL/min/1.73 m(2) and the median proteinuria was 0.4 g/day [interquartile range (IQR) 0.1-1.1]. The incidence of mild and severe anemia was 13.7/100 patients-year and 6.2/100 patients-year, respectively. Basal predictors of either mild or severe anemia were diabetes, lower hemoglobin, higher serum phosphate, eGFR <30 mL/min/1.73 m(2) and proteinuria >0.50 g/day. Male sex, moderate CKD (eGFR 30-44 mL/min/1.73 m(2)) and moderate proteinuria (0.15-0.50 g/day) predicted only mild anemia. The incidence of anemia increased progressively with CKD stages (from 8.77 to 76.59/100 patients-year) and the proteinuria category (from 13.99 to 25.02/100 patients-year). During a median follow-up of 3.1 years, 232 patients reached ESKD and 135 died. Compared with non-anemic patients, mild anemia was associated with a higher adjusted risk of ESKD hazard ratio [HR] 1.42 [95% confidence interval (CI) 1.02-1.98] and all-cause death [HR 1.55 (95% CI 1.04-2.32)]. Severe anemia was associated with an even higher risk of ESKD [HR 1.73 (95% CI 1.20-2.51)] and death [HR 1.83 (95% CI 1.05-3.19)]. CONCLUSIONS: New-onset anemia is frequent, particularly in patients with more severe renal damage and in those with diabetes mellitus. The occurrence of anemia, even of a mild degree, is associated with mortality risk and faster progression towards ESKD. CI - (c) The Author(s) 2022. Published by Oxford University Press on behalf of the ERA. FAU - Minutolo, Roberto AU - Minutolo R AUID- ORCID: 0000-0001-5686-2089 AD - Nephrology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy. FAU - Provenzano, Michele AU - Provenzano M AD - Nephrology Unit, Department of Health Sciences, "Magna Graecia," University of Catanzaro, Catanzaro, Italy. FAU - Chiodini, Paolo AU - Chiodini P AD - Medical Statistics Unit, University of Campania "Luigi Vanvitelli," Naples, Italy. FAU - Borrelli, Silvio AU - Borrelli S AD - Nephrology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy. FAU - Garofalo, Carlo AU - Garofalo C AD - Nephrology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy. FAU - Andreucci, Michele AU - Andreucci M AD - Nephrology Unit, Department of Health Sciences, "Magna Graecia," University of Catanzaro, Catanzaro, Italy. FAU - Liberti, Maria Elena AU - Liberti ME AD - Nephrology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy. FAU - Bellizzi, Vincenzo AU - Bellizzi V AD - Nephrology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy. FAU - Conte, Giuseppe AU - Conte G AD - Nephrology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy. FAU - De Nicola, Luca AU - De Nicola L AUID- ORCID: 0000-0001-8532-0182 AD - Nephrology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy. CN - Collaborative Study Group on the Conservative Treatment of CKD of the Italian Society of Nephrology LA - eng PT - Journal Article DEP - 20220112 PL - England TA - Clin Kidney J JT - Clinical kidney journal JID - 101579321 PMC - PMC9155211 OTO - NOTNLM OT - ESKD OT - anemia OT - epidemiology OT - non-dialysis CKD FIR - De Nicola, L IR - De Nicola L FIR - Minutolo, R IR - Minutolo R FIR - Zamboli, P IR - Zamboli P FIR - Iodice, F C IR - Iodice FC FIR - Borrelli, S IR - Borrelli S FIR - Chiodini, P IR - Chiodini P FIR - Signoriello, S IR - Signoriello S FIR - Gallo, C IR - Gallo C FIR - Conte, G IR - Conte G FIR - Cianciaruso, B IR - Cianciaruso B FIR - Pota, A IR - Pota A FIR - Nappi, F IR - Nappi F FIR - Avella, F IR - Avella F FIR - Di Iorio, B R IR - Di Iorio BR FIR - Bellizzi, V IR - Bellizzi V FIR - Cestaro, R IR - Cestaro R FIR - Martignetti, V IR - Martignetti V FIR - Morrone, L IR - Morrone L FIR - Lupo, A IR - Lupo A FIR - Abaterusso, C IR - Abaterusso C FIR - Donadio, C IR - Donadio C FIR - Bonomini, M IR - Bonomini M FIR - Sirolli, V IR - Sirolli V FIR - Casino, F IR - Casino F FIR - Lopez, T IR - Lopez T FIR - Detomaso, F IR - Detomaso F FIR - Giannattasio, M IR - Giannattasio M FIR - Virgilio, M IR - Virgilio M FIR - Tarantino, G IR - Tarantino G FIR - Cristofano, C IR - Cristofano C FIR - Tuccillo, S IR - Tuccillo S FIR - Chimienti, S IR - Chimienti S FIR - Petrarulo, F IR - Petrarulo F FIR - Giancaspro, V IR - Giancaspro V FIR - Strippoli, M IR - Strippoli M FIR - Laraia, E IR - Laraia E FIR - Gallucci, M IR - Gallucci M FIR - Gigante, B IR - Gigante B FIR - Lodeserto, C IR - Lodeserto C FIR - Santese, D IR - Santese D FIR - Montanaro, A IR - Montanaro A FIR - Giordano, R IR - Giordano R FIR - Caglioti, A IR - Caglioti A FIR - Fuiano, G IR - Fuiano G FIR - Zoccali, C IR - Zoccali C FIR - Caridi, G IR - Caridi G FIR - Postorino, M IR - Postorino M FIR - Savica, V IR - Savica V FIR - Monardo, P IR - Monardo P FIR - Bellinghieri, G IR - Bellinghieri G FIR - Santoro, D IR - Santoro D FIR - Castellino, P IR - Castellino P FIR - Rapisarda, F IR - Rapisarda F FIR - Fatuzzo, P IR - Fatuzzo P FIR - Messina, A IR - Messina A FIR - Dal Canton, A IR - Dal Canton A FIR - Esposito, V IR - Esposito V FIR - Formica, M IR - Formica M FIR - Segoloni, G IR - Segoloni G FIR - Gallieni, M IR - Gallieni M FIR - Locatelli, F IR - Locatelli F FIR - Tarchini, R IR - Tarchini R FIR - Meneghel, G IR - Meneghel G FIR - Oldrizzi, L IR - Oldrizzi L FIR - Cossu, M IR - Cossu M FIR - Di Giulio, S IR - Di Giulio S FIR - Malaguti, M IR - Malaguti M FIR - Pizzarelli, F IR - Pizzarelli F FIR - Quintaliani, G IR - Quintaliani G FIR - Cianciaruso, B IR - Cianciaruso B FIR - Pisani, A IR - Pisani A FIR - Conte, G IR - Conte G FIR - De Nicola, L IR - De Nicola L FIR - Minutolo, R IR - Minutolo R FIR - Bonofiglio, R IR - Bonofiglio R FIR - Fuiano, G IR - Fuiano G FIR - Grandaliano, G IR - Grandaliano G FIR - Bellinghieri, G IR - Bellinghieri G FIR - Santoro, D IR - Santoro D FIR - Cianciaruso, B IR - Cianciaruso B FIR - Russo, D IR - Russo D FIR - Pota, A IR - Pota A FIR - Di Micco, L IR - Di Micco L FIR - Torraca, S IR - Torraca S FIR - Sabbatini, M IR - Sabbatini M FIR - Pisani, A IR - Pisani A FIR - Bellizzi, V IR - Bellizzi V EDAT- 2022/06/07 06:00 MHDA- 2022/06/07 06:01 PMCR- 2022/01/12 CRDT- 2022/06/06 14:11 PHST- 2021/08/31 00:00 [received] PHST- 2022/06/06 14:11 [entrez] PHST- 2022/06/07 06:00 [pubmed] PHST- 2022/06/07 06:01 [medline] PHST- 2022/01/12 00:00 [pmc-release] AID - sfac004 [pii] AID - 10.1093/ckj/sfac004 [doi] PST - epublish SO - Clin Kidney J. 2022 Jan 12;15(6):1120-1128. doi: 10.1093/ckj/sfac004. eCollection 2022 Jun.