Hemoglobin (Hb) levels exceeding 12 g/dL are associated with the best health-related quality of life scores and outcomes in patients with nondialysis chronic kidney disease (ND-CKD), according to new study findings.

“This suggests that [Hb] levels greater than the current recommendations of 10.0-11.5 g/dL may benefit patients with ND-CKD,” Ronald L. Pisoni, PhD, MS, of Arbor Research Collaborative for Health, in Ann Arbor, Michigan, and colleagues wrote in the Journal of Renal Nutrition

The investigators asked 2121 patients with stage 3 to 5 CKD (mean age 68 years; 48% female) from CKDopps clinics in the United States and Brazil to complete the Kidney Disease Quality of Life Instrument (KDQOL-36) and Rapid Assessment of Physical Activity survey. Severely anemic patients with Hb levels less than 10 g/dL had the worst health-related quality of life (HRQoL) scores, but even moderately anemic patients with Hb 10 to 12 g/dL had subpar scores compared with mildly or non-anemic patients (Hb exceeding 12 g/dL).

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In unadjusted analyses, severely and moderately anemic patients scored lower than mildly or non-anemic patients in the domains of general health (39 vs 44 vs 47, respectively), emotional role (60 vs 65 vs 69), physical role (41 vs 49 vs 56), and burden (58 vs 67 vs 74) and effects (73 vs 80 vs 84) of kidney disease. Moderate anemia and severe anemia were associated with 26% and 78% higher risks for CKD progression (defined as a 40% decline in estimated glomerular filtration rate [eGFR], less than 10 mL/min/1.73 m2, or end-stage renal disease), respectively, and 40% and 313% higher risks for early death, respectively.

Patients with Hb exceeding 10.5 g/dL were more likely to report high levels of physical activity. Being physically inactive was associated with a 62% increased risk for death and 17% increased risk of CKD progression compared with being highly active. The investigators adjusted progression and mortality results for a range of factors including age, sex, black race, country, smoking status, eGFR, body mass index, serum albumin, macroalbuminuria, diabetes, lung disease, congestive heart failure, and comorbidity score.

“This multicenter international study provides real-world observational evidence for greater HRQOL, physical activity, lower CKD progression, and greater survival in ND-CKD patients with [Hb] levels >12 g/dL, exceeding current treatment guideline recommendations,” the authors wrote. “These findings help inform future studies aimed at understanding the impact of new anemia therapies and physical activity regimens on improving particular dimensions of ND-CKD patient well-being and clinical outcomes.”

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

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Hoshino J, Muenz D, Zee J, et al. Associations of hemoglobin levels with health-related quality of life, physical activity, and clinical outcomes in persons with stage 3-5 nondialysis CKD [published online January 21, 2020]. J Renal Nutr. doi: 10.1053/j.jrn.2019.11.003