Despite recent research suggesting that anemia and chronic kidney disease (CKD) have a combined effect on mortality, only anemia proved a harbinger of death in a new Japanese study.

Of 62,931 men and women aged 40 to 74 years from Japan’s health check program, 828 died during 2008 to 2012. These deaths represented 2.3% of anemic (hemoglobin levels below 13.0 g/dL for men and 12.0 g/dL for women) and 1.2% of non-anemic patients. Malignancy was a top cause of death in this short period. Multivariate analysis showed that the risk for all-cause mortality was significantly higher for anemic patients, regardless of their estimated glomerular filtration (eGFR), according to results published online in Clinical Experimental Nephrology. Yuji Sato, MD, of the University of Miyazaki Hospital, and colleagues employed an equation specific to the Japanese population to stratify patients by eGFR: below 45, 45 to 59, and 60 mL/min/1.73 m2 and above. Using propensity score matching, the team confirmed worse survival in anemic patients, but found no significant correlations by eGFR.

“In our general Japanese population cohort, there was no clear synergic effect of anemia and CKD on mortality,” Dr Sato’s team stated. “Anemia is an independent risk factor for all-cause mortality.” The researchers had no data on the possible underlying causes of anemia, such as iron profile, erythropoietin concentration, C-reactive protein level, or nutritional status, which is a study limitation. They encouraged clinicians to investigate and address the root causes of anemia in each patient.

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Sato Y, Fujimoto S, Konta T, et al. Anemia as a risk factor for all-cause mortality: obscure synergic effect of chronic kidney disease. Clin Exp Nephrol. doi: 10.1007/s10157-017-1468-8