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Anemia as a risk factor for all-cause mortality: obscure synergic effect of chronic kidney disease



Anemia is common in chronic kidney disease (CKD) and may be associated with mortality in CKD patients. However, few studies have examined this relationship in Asian populations.


A total of 62,931 Japanese people (age 64.0 ± 8.0 years; men 38.5%) were followed up from 2008 to 2012. Participants were divided into six groups in accordance with their estimated glomerular filtration rate (eGFR) (<45, 45–59, ≥60 mL/min/1.73 m2) and by hemoglobin levels (13.0 g/dL for men; 12.0 g/dL for women). Hazard ratio and confidence interval (CI) for mortality with a combination of eGFR and anemia were calculated. After matching using propensity score (PS) for anemia, survival analysis between anemic and non-anemic people, independent from some variables, including eGFR, was performed.


A total of 828 (1.3%) participants died (non-anemic vs. anemic, 1.2 vs. 2.3%, p < 0.01). Multivariable Cox analysis showed that, independent of eGFR levels, anemic people had significantly higher mortality. Anemic people were found to have significantly poorer survival than non-anemic people as per a log-rank test (p < 0.01) for the PS-matching cohort. Further stratified logistic analysis using PS in the overall cohort odds ratio (95% CI) showed 2.25 (1.89–2.67) with p < 0.01.


The results of the present study showed that anemia was an independent risk factor of all-cause mortality.

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This work was supported by the Health and Labor Sciences Research Grants for “Design of the Comprehensive Health Care System for Chronic Kidney Disease Based on the Individual Risk Assessment by Specific Health Check” from the Ministry of Health, Labour and Welfare of Japan, and a Grant-in-Aid for “Research on Advanced Chronic Kidney Disease (REACH-J), Practical Research Project for Renal Disease” from the Japan Agency for Medical Research and Development.

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Authors and Affiliations



YS designed the study, analyzed the data, and wrote the manuscript. SF participated in designing the study as well as in collecting and analyzing the data. TK, KI, TM, KY, KT, IN, MK, MK, YS, KA, and TW contributed to the study design, data collection, study supervision, and manuscript revision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yuji Sato.

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The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

Ethics Committees and Institutional Review Boards at the main institutes and each participating center approved the trial (approval numbers: 1485 and 2771 in Fukushima Medical University). This article does not contain any studies with animals performed by the authors.

Informed consent

Informed consent was not obtained from each participant because all data were anonymized before analysis.

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Sato, Y., Fujimoto, S., Konta, T. et al. Anemia as a risk factor for all-cause mortality: obscure synergic effect of chronic kidney disease. Clin Exp Nephrol 22, 388–394 (2018).

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  • Anemia
  • All-cause mortality
  • Chronic kidney disease
  • Propensity score