Anemia and cardiovascular disease, hospitalization, end stage renal disease, and death in older patients with chronic kidney disease

Int Urol Nephrol. 2005;37(2):395-402. doi: 10.1007/s11255-004-3068-2.


Background: Large observational studies examining the association between anemia and "hard" clinical outcomes are rare in patients with chronic kidney disease (CKD).

Methods: We used the General Medicare 5% Denominator Files to identify patients aged 67 years or more with CKD on December 31, 1999. Outcomes in the ensuing 2 years were compared in patients with and those without anemia (entry period, 1998-1999; follow-up period, 2000-2001).

Results: Of 41,522 CKD patients identified, 49.0% had claims of anemia diagnosis. The factors associated (p< 0.0001) with anemia included older age, female gender, black race, and all 10 comorbid conditions studied; adjusted odds ratios (ORs) exceeded 1.5 for age 80 years old or older (OR, 1.54 compared to <70 years), for black race (OR, 1.52), and for co-existing diagnoses of congestive heart failure (OR, 1.64), gastrointestinal bleeding (OR, 3.65), and liver disease (OR, 2.16). During the follow-up period, outcome event rates (expressed per 1000 patient-years) were as follows: renal replacement therapy, 23.5; death, 186.4; congestive heart failure, 390.0; atherosclerotic vascular disease, 410.5; and first hospitalization, 552.6. Using proportional hazards modeling, the presence of anemia was associated (p < 0.0001) with the following adjusted hazards ratios: atherosclerotic vascular disease, 1.09; congestive heart failure, 1.14; renal replacement therapy, 2.61 and death, 1.40.

Conclusion: A diagnosis of anemia is present in nearly half of all patients with CKD, aged 67 years or more, a group at very high risk of cardiovascular disease, hospitalization, end-stage renal disease, and death. Anemia is associated with each of these events.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anemia / etiology*
  • Chronic Disease
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Hospitalization*
  • Humans
  • Kidney Diseases / complications*
  • Kidney Diseases / mortality
  • Kidney Diseases / therapy
  • Kidney Failure, Chronic / etiology*
  • Male
  • Retrospective Studies