Anemia may lead to chronic kidney disease (CKD) progression and kidney failure, new study findings suggest.

Among 3919 patients with mild-to-moderate CKD within the Chronic Renal Insufficiency Cohort (CRIC) study, 1859 (47%) had anemia at baseline, defined as a hemoglobin level of less than 12 g/dL in women and less than 13 g/dL in men.

End-stage kidney disease (ESKD) developed in 1010 patients over a median 7.8 years. In multivariable analyses, patients with anemia had a 1.6-fold higher riskor ESKD compared with those without anemia, Santosh L. Saraf, MD, of the University of Illinois at Chicago, and colleagues reported in Kidney360. In stratified analyses, men with anemia, but not women, had a significant 2.2-fold higher risk for kidney failure. The association between anemia and ESKD was significant among major racial categories except non-Hispanic Black. Individuals with anemia in the non-Hispanic White, Hispanic, and “Other” categories had a 2.2-, 1.9-, and 2.9-fold higher risk for kidney failure, respectively, than their counterparts without anemia. Having a hemoglobin level of less than 13.1 g/dL was associated with increased risk for kidney failure. Anemia status did not correlate with all-cause death.

Continue Reading

“The mechanisms underlying the association of anemia with CKD progression are not clear,” Dr Saraf’s team wrote. “However, it has been hypothesized that anemia may result in tissue hypoxia and subsequently lead to cytokine release, resulting kidney scarring, as well as increased sympathetic activity.”

A strength of this study is the use of marginal structural models that limited time-dependent confounding, specifically anemia resulting from CKD progression.

Future studies are needed to identify and test alternative anemia therapies (to erythropoiesis stimulating agents) and whether they slow CKD progression, according to the investigators.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Saraf SL, Hsu JY, Ricardo AC, et al; CRIC Investigators. Anemia and incident end-stage kidney disease. Kidney360. 1(7):623-630. doi: 10.34067/KID.0000852020