Prevalence of anemia according to stage of chronic kidney disease in a large screening cohort of Japanese

  • Kentaro Kohagura
  • Nozomi Tomiyama
  • Kozen Kinjo
  • Shuichi Takishita
  • Kunitoshi Iseki
Original Article

Abstract

Background

The prevalence of chronic kidney disease (CKD) is high in developed countries, including Japan. However, little is known about the prevalence of anemia according to the estimated glomerular filtration rate (eGFR) among Japanese.

Methods

We studied screenees on the Okinawa General Health Maintenance Association (OGHMA) registry in 1993 (N = 94,602; 54,848 women and 39,754 men) who had both serum creatinine and hematocrit data. Anemia was defined as follows: hematocrit level <40% in men, <32% in women aged <50 years, and <35% in women aged ≥50 years. GFR was estimated using a new Japanese equation: eGFR (ml/min per 1.73 m2) = 194 × serum creatinine1.094 × age0.287 × 0.739 (if female).

Results

The prevalence of anemia clearly increased as CKD progressed below an eGFR of 60 ml/min per 1.73 m2 in both genders. Logistic analysis adjusted with body mass index and older age (≥70 years) revealed that the odds ratio for complications of anemia was significantly increased below an eGFR of 45 ml/min per 1.73 m2 in women and 90 ml/min per 1.73 m2 in men. The association of lower kidney function with anemia was found to be more prevalent: adjusted odds ratio ≥2.0, from approximately 50 ml/min per 1.73 m2.

Conclusion

The present study suggested that there might be as many as 1,000,000 people with CKD stage 3–5 complicated with anemia in Japan.

Keywords

Chronic kidney disease Anemia 

References

  1. 1.
    Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;51:1296–305.CrossRefGoogle Scholar
  2. 2.
    Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003;108:2154–69.CrossRefPubMedGoogle Scholar
  3. 3.
    Ninomiya T, Kiyohara Y, Kubo M, Tanizaki Y, Doi Y, Okubo K, et al. Chronic kidney disease and cardiovascular disease in a general Japanese population: the Hisayama study. Kidney Int. 2005;68:228–36.CrossRefPubMedGoogle Scholar
  4. 4.
    Sarnak MJ, Tighiouart H, Manjunath G, MacLeod B, Griffith J, Salem D, et al. Anemia as a risk factor for cardiovascular disease in the atherosclerosis risk in communities (ARIC) study. J Am Coll Cardiol. 2002;40:27–33.CrossRefPubMedGoogle Scholar
  5. 5.
    Jurkovitz CT, Abramson JL, Vaccarino LV, Weintraub WS, McClellan WM. Association of high serum creatinine and anemia increases the risk of coronary events: results from the prospective community-based atherosclerosis risk in communities (ARIC) study. J Am Soc Nephrol. 2003;14:2919–25.CrossRefPubMedGoogle Scholar
  6. 6.
    Muntner P, He J, Astor BC, Folsom AR, Coresh J. Traditional and nontraditional risk factors predict coronary heart disease in chronic kidney disease: results from the atherosclerosis risk in communities study. J Am Soc Nephrol. 2005;16:529–38.CrossRefPubMedGoogle Scholar
  7. 7.
    Leeder SR, Mitchell P, Liew G, Rochtchina E, Smith W, Wang JJ. Low hemoglobin, chronic kidney disease, and risk for coronary heart disease-related death: the Blue Mountains eye study. J Am Soc Nephrol. 2006;17:279–84.CrossRefPubMedGoogle Scholar
  8. 8.
    Abramson JL, Jurkovitz CT, Vaccarino V, Weintraub WS, McClellan W. Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: the ARIC Study. Kidney Int. 2003;64:610–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Silverberg D, Wexler D, Blum M, Wollman Y, Iaina A. The cardio-renal anaemia syndrome: does it exist? Nephrol Dial Transplant. 2003;18(Suppl 8):viii7–12.PubMedGoogle Scholar
  10. 10.
    Coresh J, Byrd-Holt D, Astor BC, Briggs JP, Eggers PW, Lacher DA, et al. Chronic kidney disease awareness, prevalence, and trends among US adults, 1999 to 2000. J Am Soc Nephrol. 2005;16:180–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Meisinger C, Doring A, Lowel H. Chronic kidney disease and risk of incident myocardial infarction and all-cause and cardiovascular disease mortality in middle-aged men and women from the general population. Eur Heart J. 2006;27:1245–50.CrossRefPubMedGoogle Scholar
  12. 12.
    Imai E, Horio M, Iseki K, Yamagata K, Watanabe T, Hara S, et al. Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient. Clin Exp Nephrol. 2007;11:156–63.CrossRefPubMedGoogle Scholar
  13. 13.
    Chen J, Wildman RP, Gu D, Kusek JW, Spruill M, Reynolds K, et al. Revalence of decreased kidney function in Chinese adults aged 35 to 74 years. Kidney Int. 2005;68:2837–45.CrossRefPubMedGoogle Scholar
  14. 14.
    Fehr T, Ammann P, Garzoni D, Korte W, Fierz W, Rickli H, et al. Interpretation of erythropoietin levels in patients with various degrees of renal insufficiency and anemia. Kidney Int. 2004;66:1206–11.CrossRefPubMedGoogle Scholar
  15. 15.
    Hsu CY, McCulloch CE, Curhan GC. Epidemiology of anemia associated with chronic renal insufficiency among adults in the United States: results from the Third National Health and Nutrition Examination Survey. J Am Soc Nephrol. 2002;13:504–10.CrossRefPubMedGoogle Scholar
  16. 16.
    Astor BC, Muntner P, Levin A, Eustace JA, Coresh J. Association of kidney function with anemia: the Third National Health and Nutrition Examination Survey (1988–1994). Arch Intern Med. 2002;162:1401–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis. 2003;41:1–12.CrossRefPubMedGoogle Scholar
  18. 18.
    Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised Equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009; (in press).Google Scholar
  19. 19.
    Iseki K, Kinjo K, Iseki C, Takishita S. Relationship between predicted creatinine clearance and proteinuria and the risk of developing ESRD in Okinawa, Japan. Am J Kidney Dis. 2004;441:806–14.CrossRefGoogle Scholar
  20. 20.
    Gejyo F, Saito A, Akizawa T, Akiba T, Sakai T, Suzuki M, et al. 2004 Japanese Society for dialysis therapy guidelines for renal anemia in chronic hemodialysis patients. Ther Apher Dial. 2004;37:1737–63.Google Scholar
  21. 21.
    NKF-DOQI clinical practice guidelines for the treatment of anemia of chronic renal failure. National Kidney Foundation-Dialysis Outcomes Quality Initiative, Am J Kidney Dis. 1997;30(4 Suppl 3):S192–240.Google Scholar
  22. 22.
    JSDT guideline for renal anemia in chronic kidney disease (2008). (http://www.jsdt.or.jp in Japanese).
  23. 23.
    Ble A, Fink JC, Woodman RC, Klausner MA, Windham BG, Guralnik JM, et al. Renal function, erythropoietin, and anemia of older persons: the InCHIANTI study. Arch Intern Med. 2005;165:2222–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Imai E, Horio M, Yamagata K, Iseki K, Watanabe T, Hara S, et al. Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient. Hypertens Res. 2008;31:433–41.CrossRefPubMedGoogle Scholar
  25. 25.
    Hsu CY, Bates DW, Kuperman GJ, Curhan GC. Relationship between hematocrit and renal function in men and women. Kidney Int. 2001;59:725–31.CrossRefPubMedGoogle Scholar
  26. 26.
    Iseki K, Nakai S, Shinzato T, Nagura Y, Akiba T. Increasing gender difference in the incidence of chronic dialysis therapy in Japan. Ther Apher Dial. 2005;9:407–11.CrossRefPubMedGoogle Scholar
  27. 27.
    Brockenbrough AT, Dittrich MO, Page ST, Smith T, Stivelman JC, Bremner WJ. Transdermal androgen therapy to augment EPO in the treatment of anemia of chronic renal disease. Am J Kidney Dis. 2006;47:251–62.CrossRefPubMedGoogle Scholar
  28. 28.
    Mukundan H, Kanagy NL, Resta TC. 17-beta estradiol attenuates hypoxic induction of HIF-1alpha and erythropoietin in Hep3B cells. J Cardiovasc Pharmacol. 2004;44:93–100.CrossRefPubMedGoogle Scholar
  29. 29.
    Silverberg DS, Wexler D, Blum M, Schwartz D, Wollman Y, Iaina A. Erythropoietin should be part of congestive heart failure management. Kidney Int Suppl. 2003;87:S40–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Drueke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, et al. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med. 2006;355:2071–84.CrossRefPubMedGoogle Scholar
  31. 31.
    Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006;355:2085–98.CrossRefPubMedGoogle Scholar
  32. 32.
    Phrommintikul A, Haas SJ, Elsik M, Krum H. Mortality and target haemoglobin concentrations in anaemic patients with chronic kidney disease treated with erythropoietin: a meta-analysis. Lancet. 2007;369:381–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Chaves PH, Ashar B, Guralnik JM, Fried LP. Looking at the relationship between hemoglobin concentration and prevalent mobility difficulty in older women. Should the criteria currently used to define anemia in older people be reevaluated? J Am Geriatr Soc. 2002;50:1257–64.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2009

Authors and Affiliations

  • Kentaro Kohagura
    • 1
  • Nozomi Tomiyama
    • 1
  • Kozen Kinjo
    • 2
  • Shuichi Takishita
    • 1
  • Kunitoshi Iseki
    • 3
  1. 1.Department of Cardiovascular Medicine, Nephrology and NeurologyUniversity of the RyukyusOkinawaJapan
  2. 2.Okinawa General Health Maintenance AssociationOkinawaJapan
  3. 3.Dialysis UnitUniversity of the RyukyusOkinawaJapan

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