Even mild anemia may lead to cardiac events in chronic kidney disease (CKD) patients following elective percutaneous coronary intervention (PCI), according to study findings presented at Kidney Week 2015.

Yuichiro Kitai, MD, and colleagues at the Kyoto University Graduate School of Medicine in Japan, examined major adverse cardiac events (MACE) in 2,792 CKD patients who underwent a first PCI during the period 2005–2007 within the Coronary REvascularization Demonstrating Outcome study in Kyoto (CREDO-Kyoto) cohort-2. MACE included myocardial infarction, heart failure hospitalization, and death from any cause.

Among the 2,792 patients, 26.4% had mild anemia (hemoglobin 11.0–11.9 g/dL for women and 11.0–12.9 g/dL for men), and 17.9% had moderate-to-severe anemia (hemoglobin below 11.0 g/dL). Within 3 years, MACE occurred significantly more frequently in patients with anemia than in those without the condition (23.5% and 37.4% in patients with mild and moderate-to-severe anemia, respectively, vs. 12.2% in patients without anemia). That translated into 46% and 76% greater odds for MACE in anemic patients, respectively.

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Investigators further observed that the risk for MACE rose along with worsening anemia or renal function. “Anemia and reduced renal function independently and additively increased the risk for MACE in these patients,” co-investigator Motoko Yanagita, MD, PhD, told Renal & Urology News. “Current guidelines recommend the target hemoglobin level should generally be in the range of 11.0–12.0 g/dL and should not be greater than 13.0 g/dL in CKD patients with anemia. However, it is unknown whether this recommendation is applicable to CKD patients with coronary artery disease. There is still no randomized controlled trial about the target hemoglobin level in these patients.” 

The investigators acknowledged that they did not examine the etiologies of anemia or the dosages of erythropoietin-stimulating agents and iron supplements in this study. Future research is needed to clarify anemia treatment strategies in CKD patients with coronary artery disease.