Association of kidney function with anemia: the Third National Health and Nutrition Examination Survey (1988-1994)

Arch Intern Med. 2002 Jun 24;162(12):1401-8. doi: 10.1001/archinte.162.12.1401.

Abstract

Background: Kidney failure is known to cause anemia, which is associated with a higher risk of cardiac failure and mortality. The impact of milder decreases in kidney function on hemoglobin levels and anemia in the US population, however, is unknown.

Methods: We analyzed a population-based sample of 15419 participants 20 years and older in the Third National Health and Nutrition Examination Survey, conducted from 1988 to 1994.

Results: Lower kidney function was associated with a lower hemoglobin level and a higher prevalence and severity of anemia below, but not above, an estimated glomerular filtration rate (GFR) of 60 mL/min per 1.73 m(2). Adjusted to the age of 60 years, the predicted median hemoglobin level among men (women) decreased from 14.9 (13.5) g/dL at an estimated GFR of 60 mL/min per 1.73 m(2) to 13.8 (12.2) g/dL at an estimated GFR of 30 mL/min per 1.73 m(2) and to 12.0 (10.3) g/dL at an estimated GFR of 15 mL/min per 1.73 m(2). The prevalence of anemia (hemoglobin level <12 g/dL in men and <11 g/dL in women) increased from 1% (95% confidence interval, 0.7%-2%) at an estimated GFR of 60 mL/min per 1.73 m(2) to 9% (95% confidence interval, 4%-19%) at an estimated GFR of 30 mL/min per 1.73 m(2) and to 33% (95% confidence interval, 11%-67%) at an estimated GFR of 15 mL/min per 1.73 m(2) among men and to 67% (95% confidence interval, 30%-90%) at an estimated GFR of 15 mL/min per 1.73 m(2) among women. An estimated GFR of 15 to 60 mL/min per 1.73 m(2) was present in 4% of the entire population and in 17% of the individuals with anemia.

Conclusion: Below an estimated GFR of 60 mL/min per 1.73 m(2), lower kidney function is strongly associated with a higher prevalence of anemia among the US adult population.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Anemia, Hypochromic / epidemiology*
  • Anemia, Hypochromic / ethnology
  • Anemia, Hypochromic / etiology*
  • Cross-Sectional Studies
  • Female
  • Glomerular Filtration Rate*
  • Hemoglobins / analysis
  • Humans
  • Iron / blood
  • Iron / deficiency
  • Kidney / physiopathology
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / physiopathology
  • Male
  • Middle Aged
  • Odds Ratio
  • Predictive Value of Tests
  • Prevalence
  • Risk Factors
  • Severity of Illness Index
  • United States / epidemiology

Substances

  • Hemoglobins
  • Iron