Anemia Development and Cardiovascular Risk Management in Nonanemic Stage 3 Chronic Kidney Disease

Abstract

Background/Aim. There is little information on the development of anemia in the early stages of chronic kidney disease. The aim of this study was to analyze the onset of renal anemia in a cohort of initially nonanemic chronic kidney disease patients followed up in nephrology clinics. Methods. This epidemiological, prospective, three-year, multicenter study enrolled patients aged 18–78 years with stage 3 chronic kidney disease without anemia. Interim analysis was performed on the data collected during the first 12 months. Results. The study included 432 patients, average age 63.6 years (range 22–78 years, 70% male). The main etiologies of chronic kidney disease were glomerular (11.6%), interstitial (10.4%), vascular (29.4%), and diabetic (16.9%). The percentages of patients with comorbidities were 33.8% diabetes (2.5% type 1), 69% dyslipidemia, and 93% hypertension. During the first year, 12.4% of patients developed anemia. The chronic kidney disease progression rate was low: proteinuria was 0.46 ± 0.8 g/24 h at one year versus 0.67 ± 1.0 g/24 h at baseline. Diabetic patients showed a greater prevalence of previous cardiovascular events (50.0% vs. 24.5%) and worse control of some modifiable cardiovascular risk factors: smoking (13.4% vs. 8.6%), obesity (BMI > 30 kg/m², 33.6% vs. 25.3%), target blood pressure (<130/80 mmHg, 21.0% vs. 27.9%), and proteinuria (0.8 ± 1.1 vs. 0.6 ± 0.9 g/day). Conclusions. After one year, 12.4% of patients developed anemia. Diabetic patients had a higher cardiovascular risk and limited blood pressure control. The overall control of cardiovascular risk was unsatisfactory.

Keywords:

• chronic kidney disease
• anemia
• cardiovascular risk
• diabetes
• epidemiology

ACKNOWLEDGMENTS

This study has been conducted by the above-signed authors and the GEENDIAB-SEN Group (in alphabetical order): Dr. Vicente Álvarez Chivas, H. de La Princesa (Madrid); Dr. Pedro Aranda, H. Carlos Haya (Málaga); Dr. Jesús Mª Arteaga Coloma, H. de Navarra; Dra. Josefa Borrego, Complejo Hosp. de Jaén (Jaen); Dr. Jesús Bustamante Bustamante, H. Clínico de Valladolid (Valladolid); Dra. Francisca Calero, Fundació Puigvert (Barcelona); Dra. Camino, H. Central de Asturias (Oviedo); Dr. Aleix Cases Amenós, H. Clínic (Barcelona); Dr. José Conde, H. de Toledo (Toledo); Dr. Fernando de Álvaro, H. La Paz (Madrid); Dr. Francisco Fernández Vega, H. Central de Asturias (Oviedo); Dr. Florencio García Martín, H. 12 de Octubre (Madrid); Dr. Joan Gascó González, H. Son Llatzer (Palma de Mallorca); Dr. José Luis Gorriz Teruel, H. Dr. Peset (Valencia); Dr. Manuel Granda Rodríguez, H. Virgen Blanca (León); Dr. José María Graña Fandos, H. de La Rivera (Valencia); Dr. Enrique Gruss Vergara, H. U. Fundación Alcorcón (Madrid). Dr. Pablo Íñigo Gil, H. Clínico Universitario Lozano Blesa (Zaragoza); Dra. Dolores Lorenzo, H. Juan Canalejo (A Coruña); Dr. Rafael Marín Iranzo, H. Central de Asturias (Oviedo); Dr. Alberto Martínez Castelao, H. de Bellvitge (Barcelona); Dra. Isabel Martínez Fernández, H. de Galdakao (Vizcaya); and Dr. Javier Nieto Iglesias, H. Gral. de Ciudad Real (Ciudad Real).

This study was supported financially by Amgen S.A., which also provided editorial assistance for the preparation of this manuscript. The authors have previously attended advisory boards for Amgen S.A. This study has been designed and performed by the authors and the GEENDIAB Group of the Spanish Society of Nephrology.