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Impact of hemoglobin levels on renal and non-renal clinical outcomes differs by chronic kidney disease stages: the Gonryo study

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An Erratum to this article was published on 26 June 2017

Abstract

Background

Anemia greatly affects the development of renal and cardiovascular outcomes in chronic kidney disease (CKD) patients. However, the impact based on CKD stage remains unclear.

Methods

We prospectively followed 2,602 Japanese CKD patients under the care of nephrologists. CKD was defined according to cause, estimated glomerular filtration rate <60 mL/min, and/or proteinuria. Patient outcomes [primary end-points: cardiovascular events (CVEs), all-cause mortality, and end-stage kidney disease (ESKD) requiring renal replacement therapy] were assessed in association with basal hemoglobin (Hb) levels (<10, 10–12 and ≥12 g/dL), stratified by CKD stages.

Results

During follow-up, 123 patients developed CVEs, 41 died, and 220 progressed to ESKD. For stages G3, G4 and G5, ESKD frequencies were 2.8, 64.4, and 544.8 person-years, while CVEs and death were 25.6, 45.6, and 76.3 person-years, respectively. The combined endpoint rate was significantly higher in patients with Hb <10 versus Hb 10–12 g/dL, but a higher risk for CVEs and death with Hb <10 g/dL was found only in G3 [hazard ratio (HR) 4.49, (95 % confidence interval (95 % CI) 2.06–9.80)]. In contrast, risk for ESKD with Hb <10 g/dL was found only in G4 [HR 3.08 (95 % CI 1.40–6.79)] and G5 [HR 1.43 (95 % CI 1.01–2.05)]. No increased risks with higher Hb levels were found.

Conclusion

The impact of renal anemia of Hb <10 g/dL on clinical outcomes differed by CKD stage, with a significantly high risk for CVEs and all-cause mortality in G3 and progression to ESKD in G4 and G5.

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Acknowledgments

This study was supported by grants from Astellas Pharm Inc. The authors express special thanks to Ms. Yumi Yamaguchi and Ms. Ayuko Momoi for administrative assistance. Study contributors: Yuji Yamaguchi (Japanese Red Cross Sendai Hospital), Katsuya Obara (Tohoku Kosai Hospital), Isao Kurihara (Tohoku Kosai Miyagino Hospital), Yasumichi Kinoshita and Kazuto Sato (Japanese Red Cross Ishinomaki Hospital), Kazuro Kaise (Sendai Medical Center), Akira Sugiura and Masahiro Miyata (Osaki Citizen Hospital), Kazuhisa Takeuchi (Koujinkai Central Clinic), Kenji Nakayama and Naoki Akiu (Sendai City Hospital) and Tetsuya Otaka (Katta General Hospital). This study was supported by a grant from Astellas Pharm, Inc. and Miyagi Kidney Foundation.

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Authors and Affiliations

  1. Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Tae Yamamoto, Mariko Miyazaki, Gen Yamada & Sadayoshi Ito

  2. Center for Advanced Integrated Renal Science, Tohoku University Graduate School of Medicine, Sendai, Japan

    Mariko Miyazaki, Masaaki Nakayama, Masato Matsushima, Yoshio Taguma, Hiroshi Sato & Sadayoshi Ito

  3. Division of Nephrology, Hypertension, Diabetology, Endocrinology, and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan

    Masaaki Nakayama

  4. Department of Clinical Research, The Jikei University School of Medicine, Tokyo, Japan

    Masato Matsushima

  5. Kidney Center, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan

    Mistuhiro Sato, Toshinobu Sato & Yoshio Taguma

  6. Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan

    Hiroshi Sato

Authors
  1. Tae Yamamoto
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  2. Mariko Miyazaki
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  3. Masaaki Nakayama
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  4. Gen Yamada
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  9. Hiroshi Sato
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Correspondence to Tae Yamamoto.

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The authors have declared that no conflict of interest exists.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s10157-017-1435-4.

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Yamamoto, T., Miyazaki, M., Nakayama, M. et al. Impact of hemoglobin levels on renal and non-renal clinical outcomes differs by chronic kidney disease stages: the Gonryo study. Clin Exp Nephrol 20, 595–602 (2016). https://doi.org/10.1007/s10157-015-1190-3

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  • DOI: https://doi.org/10.1007/s10157-015-1190-3

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