Effect of anaemia on mortality, cardiovascular hospitalizations and end-stage renal disease among patients with chronic kidney disease

Nephrology (Carlton). 2009 Apr;14(2):240-6. doi: 10.1111/j.1440-1797.2008.01065.x.


Objective: To determine whether an independent association exists between anaemia and chronic kidney disease (CKD) outcomes in a quasi-incidence cohort when patients' most recent laboratory values are considered.

Methods: We conducted a dynamic, retrospective cohort study among patients with incident CKD in a large health maintenance organization administrative data set. CKD was defined by two estimated glomerular filtration rates (eGFR). We measured the absolute rates for all-cause mortality, cardiovascular hospitalizations and end-stage renal disease.

Results: Our completed cases Cox regression model followed 5885 patients with both CKD and haemoglobin measures. For patients with the most severe anaemia (haemoglobin <10.5 g/dL), we estimated an increased rate of mortality (hazard ratio (HR)=5.27, CI 4.37-6.35), cardiovascular hospitalizations (HR=2.18, CI 1.76-2.70) and end-stage renal disease (HR=5.46, CI 3.38-8.82) when compared with patients who were not anaemic; the HR reflect time-varying haemoglobins and eGFR.

Conclusion: Anaemia is a predictor of excess mortality, excess cardiovascular hospitalizations and excess end-stage renal disease even when the progression of CKD is considered by controlling for time-varying eGFR values.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anemia / complications
  • Anemia / mortality*
  • Cardiovascular Diseases / mortality*
  • Chronic Disease
  • Cohort Studies
  • Female
  • Glomerular Filtration Rate
  • Hemoglobins / analysis
  • Hospitalization
  • Humans
  • Kidney Diseases / mortality*
  • Kidney Failure, Chronic / mortality*
  • Male
  • Middle Aged
  • Retrospective Studies


  • Hemoglobins