1
|
Minutolo R, Provenzano M, Chiodini P, Borrelli S, Garofalo C, Andreucci M, Liberti ME, Bellizzi V, Conte G, De Nicola L, De Nicola L, Minutolo R, Zamboli P, Iodice FC, Borrelli S, Chiodini P, Signoriello S, Gallo C, Conte G, Cianciaruso B, Pota A, Nappi F, Avella F, Di Iorio BR, Bellizzi V, Cestaro R, Martignetti V, Morrone L, Lupo A, Abaterusso C, Donadio C, Bonomini M, Sirolli V, Casino F, Lopez T, Detomaso F, Giannattasio M, Virgilio M, Tarantino G, Cristofano C, Tuccillo S, Chimienti S, Petrarulo F, Giancaspro V, Strippoli M, Laraia E, Gallucci M, Gigante B, Lodeserto C, Santese D, Montanaro A, Giordano R, Caglioti A, Fuiano G, Zoccali C, Caridi G, Postorino M, Savica V, Monardo P, Bellinghieri G, Santoro D, Castellino P, Rapisarda F, Fatuzzo P, Messina A, Dal Canton A, Esposito V, Formica M, Segoloni G, Gallieni M, Locatelli F, Tarchini R, Meneghel G, Oldrizzi L, Cossu M, Di Giulio S, Malaguti M, Pizzarelli F, Quintaliani G, Cianciaruso B, Pisani A, Conte G, De Nicola L, Minutolo R, Bonofiglio R, Fuiano G, Grandaliano G, Bellinghieri G, Santoro D, Cianciaruso B, Russo D, Pota A, Di Micco L, Torraca S, Sabbatini M, Pisani A, Bellizzi V. New-Onset Anemia and Associated Risk of ESKD and Death in Non-Dialysis CKD Patients: A Multi-Cohort Observational Study. Clin Kidney J 2022; 15:1120-1128. [PMID: 35664282 PMCID: PMC9155211 DOI: 10.1093/ckj/sfac004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Indexed: 12/03/2022] Open
Abstract
Background Anemia is a common complication of chronic kidney disease (CKD), but its incidence in nephrology settings is poorly investigated. Similarly, the risks of adverse outcomes associated with new-onset anemia are not known. Methods We performed a pooled analysis of three observational cohort studies including 1031 non-anemic CKD patients with eGFR <60 mL/min/1.73 m2 regularly followed in renal clinics. We estimated the incidence of mild anemia (hemoglobin 11–12 g/dL in women and 11–13 g/dL in men) and severe anemia (hemoglobin <11 g/dL or use of erythropoiesis-stimulating agents) during a 3-year follow-up period. Thereafter we estimated the risk of end-stage kidney disease (ESKD) and all-cause death associated with new-onset mild and severe anemia. Results The mean age was 63 ± 14 years, 60% were men and 20% had diabetes. The mean estimated glomerular filtration rate (eGFR) was 37 ± 13 mL/min/1.73 m2 and the median proteinuria was 0.4 g/day [interquartile range (IQR) 0.1–1.1]. The incidence of mild and severe anemia was 13.7/100 patients-year and 6.2/100 patients-year, respectively. Basal predictors of either mild or severe anemia were diabetes, lower hemoglobin, higher serum phosphate, eGFR <30 mL/min/1.73 m2 and proteinuria >0.50 g/day. Male sex, moderate CKD (eGFR 30–44 mL/min/1.73 m2) and moderate proteinuria (0.15–0.50 g/day) predicted only mild anemia. The incidence of anemia increased progressively with CKD stages (from 8.77 to 76.59/100 patients-year) and the proteinuria category (from 13.99 to 25.02/100 patients-year). During a median follow-up of 3.1 years, 232 patients reached ESKD and 135 died. Compared with non-anemic patients, mild anemia was associated with a higher adjusted risk of ESKD {hazard ratio [HR] 1.42 [95% confidence interval (CI) 1.02–1.98]} and all-cause death [HR 1.55 (95% CI 1.04–2.32)]. Severe anemia was associated with an even higher risk of ESKD [HR 1.73 (95% CI 1.20–2.51)] and death [HR 1.83 (95% CI 1.05–3.19)]. Conclusions New-onset anemia is frequent, particularly in patients with more severe renal damage and in those with diabetes mellitus. The occurrence of anemia, even of a mild degree, is associated with mortality risk and faster progression towards ESKD.
Collapse
Affiliation(s)
- Roberto Minutolo
- Nephrology Unit at University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Michele Provenzano
- Nephrology Unit, “Magna Graecia”, Department of Health Sciences, “Magna Graecia”, University of Catanzaro, Italy, Catanzaro, Italy
| | - Paolo Chiodini
- Medical Statistics Unit, University of Campania “Luigi Vanvitelli” Naples
| | - Silvio Borrelli
- Nephrology Unit at University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Carlo Garofalo
- Nephrology Unit at University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Michele Andreucci
- Nephrology Unit, “Magna Graecia”, Department of Health Sciences, “Magna Graecia”, University of Catanzaro, Italy, Catanzaro, Italy
| | | | - Vincenzo Bellizzi
- Nephrology Unit, University Hospital “San Giovanni di Dio e Ruggi d'Aragona” in Salerno, Italy
| | - Giuseppe Conte
- Nephrology Unit at University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Luca De Nicola
- Nephrology Unit at University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Magri P, Auletta M, Andreucci M, Somma G, Musone D, Fiorillo M, Torraca S, Antoniello S, Cianciaruso B. Sodium retention in preascitic stage of cirrhosis. Semin Nephrol 2001; 21:317-22. [PMID: 11320501 DOI: 10.1053/snep.2001.2001.21668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Renal Na+ handling abnormalities have been shown in preascitic cirrhosis. To investigate the underlying pathophysiology, the effects of different sodium intakes on Na(+) balance and renal hemodynamics were assessed at 100 mEq Na+/day (low-sodium diet [LSD]) and after 6 days of 250 mEq Na+/day (high-sodium diet [HSD]). Eight asymptomatic patients with cirrhosis (Pugh-Child A class) (PAC) and 10 healthy controls (CON) were studied. At HSD, although CON readjusted Na+ excretion within the fourth day, PAC did not reach the new balance and developed a final greater Na+ retention (+437 mEq in PAC v +228 mEq in CON, P<.001). In PAC, fractional Na+ excretion (FENa) was significantly lower than in CON at LSD (P<.05), and, after HSD, increased in both groups (P<.05). In PAC, renal vascular resistances (RVR) at LSD resulted lower than in CON (P<.05) and failed to decrease after HSD. As a consequence, after HSD, glomerular filtration rate and renal plasma flow failed to increase in PAC. PRA and plasma aldosterone were significantly lower in PAC, than in CON at LSD (P<.05), and decreased in both groups after HSD (P<.05). Proximal Na+ reabsorption (RProx) [as indicated by fractional free water clearance measured in a state of maximal water diuresis] at LSD was lower in PAC than in CON (P<.05) and decreased in both groups after HSD (P<.05). In summary, early stages of cirrhosis are characterized by: (1) a reduction of RVR, probably associated with splanchnic vasodilation; (2) a Na+ retention already at LSD, as indicated by the lower FENa observed in PAC, that produces extracellular volume (ECV) expansion, with a consequent RProx and renin-angiotensin-aldosterone axis (RAS) suppression; (3) a greater Na+ retention after HSD, associated with an abnormal adaptation of renal hemodynamic, a greater ECV expansion and a consequent Rprox and RAS suppression. These data show the presence of early renal hemodynamic dysfunction in PAC. Our findings also show in this phase of the disease a preserved adaptation of RProx and RAS, thus suggesting that the observed tubular Na+ reabsorption derangement is probably related to abnormal ANP behavior.
Collapse
Affiliation(s)
- P Magri
- Department of Nephrology, Federico II University of Naples, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|