Anemia may be a risk factor for both chronic kidney disease (CKD) development and progression in a general population.

In a study of more than a half million Korean adults aged 40 to 80 years without known CKD, end-stage renal disease (ESRD) developed in 575 women and 1047 men during a mean 10.5 years. Low-normal hemoglobin (Hb) of less than 14 g/dL in men or 12 g/dL in women correlated with increased ESRD risk, even in those with an estimated glomerular filtration rate (eGFR) greater than 60 mL/min/1.73 m2 and no albuminuria, Sang-Wook Yi, MD, PhD, of Catholic Kwandong University College of Medicine, Gangneung, Korea, and colleagues reported in PLoS One.

Any degree of albuminuria or reduction in eGFR strengthened ESRD risk. For example, Hb values of 13 to 13.9 g/dL in men or 11 to 11.9 g/dL in women with trace albuminuria (assessed by dipstick urinalysis) were associated with more than double the risk for ESRD. After adjustment, a 1 g/dL decrease in Hb was associated with significant 34%, 55%, and 75% increased ESRD risks in those with eGFR greater than 60, 30 to 59, and less than 30 mL/min/1.73 m2, respectively. Women older than 60 years appeared more susceptible than men and younger adults.

Continue Reading

Lower Hb had synergic biological interactions with lower eGFR and albuminuria that increase ESRD risk, Dr Yi and colleagues explained. “The inclusion of persons with anemia or low-normal Hb in surveillance and management programs for the primary and secondary prevention of CKD may reduce the burden of CKD.”

The investigators suggested that anemia-induced renal hypoxia might damage the kidneys.

In Korea, more than half of anemia cases are iron deficiency anemia. The researchers did not have information on the etiology of anemia for study participants, which is a limitation. The results pertain to Koreans aged 40–80 years and may not apply to younger individuals or other ethnicities.


Yi SW, Moon SJ, and Yi JJ. Low-normal hemoglobin levels and anemia are associated with increased risk of end-stage renal disease in general populations: A prospective cohort study. PLoS ONE 14(4): e0215920. doi:10.1371/journal.pone.0215920