RESEARCH ARTICLE
Albuminuria as a Risk Factor for Anemia in Chronic Kidney Disease: Result from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) Ji Suk Han1, Mi Jung Lee1, Kyoung Sook Park1, Seung Hyeok Han1, Tae-Hyun Yoo1, KookHwan Oh2, Sue Kyung Park3, Joongyub Lee4, Young Youl Hyun5, Wookyung Chung6, Yeong Hoon Kim7, Curie Ahn2, Kyu Hun Choi1* 1 Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea, 2 Department of Internal Medicine, Seoul National University, Seoul, Korea, 3 Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea, 4 Medical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea, 5 Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University, Seoul, Korea, 6 Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, Korea, 7 Department of Internal Medicine, Inje University, Pusan Paik Hospital, Busan, Korea OPEN ACCESS Citation: Han JS, Lee MJ, Park KS, Han SH, Yoo TH, Oh K-H, et al. (2015) Albuminuria as a Risk Factor for Anemia in Chronic Kidney Disease: Result from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). PLoS ONE 10(10): e0139747. doi:10.1371/journal. pone.0139747 Editor: Tatsuo Shimosawa, The University of Tokyo, JAPAN Received: May 22, 2015
* [email protected]
Abstract Background Anemia is a common complication among patients with chronic kidney disease (CKD), and it is associated with unfavorable clinical outcomes in patients with CKD independent of the estimated glomerular filtration rate (eGFR). We assessed the association of the urinary albumin-to-creatinine ratio (ACR) and eGFR with anemia in CKD patients.
Accepted: September 15, 2015 Published: October 2, 2015 Copyright: © 2015 Han et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper. Funding: This study was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention (2011-2013-E33016-02#). The study is supervised by the CKD Advisory Committee composed of the members from the KCDC and the Korean Society of Nephrology (KSN, NCT01630486 at http://www.clinicaltrials.gov). The funders had no role in study design, data collection
Methods We conducted a cross-sectional study using baseline data from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD). Multiple regression analysis was performed to identify the independent association of albuminuria with anemia. Furthermore, odds ratios for anemia were calculated by cross-categorization of ACR and eGFR.
Results Among 1,456 patients, the mean age was 53.5 ± 12.4 years, and the mean eGFR and ACR were 51.9 ± 30.5 mL/min per 1.73 m2 and 853.2 ± 1,330.3 mg/g, respectively. Anemia was present in 644 patients (40.5%). Multivariate analysis showed that the odds ratio of anemia increased according to ACR levels, after adjusting for age, sex, eGFR, body mass index, pulse pressure, cause of CKD, use of erythropoiesis stimulating agents, serum calcium and ferritin (ACR < 30 mg/g as a reference group; 30–299 mg/g, adjusted odds ratio (OR) = 1.43, 95% confidence interval (CI) = 0.88–2.33; 300 mg/g, adjusted OR = 1.86, 95% CI = 1.12–3.10). In
PLOS ONE | DOI:10.1371/journal.pone.0139747 October 2, 2015
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Albuminuria and Anemia in CKD
and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist.
addition, graded associations were observed in cross-categorized groups of a higher ACR and eGFR compared to the reference group with an ACR
Albuminuria as a Risk Factor for Anemia in Chronic Kidney Disease: Result from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) Ji Suk Han1, Mi Jung Lee1, Kyoung Sook Park1, Seung Hyeok Han1, Tae-Hyun Yoo1, KookHwan Oh2, Sue Kyung Park3, Joongyub Lee4, Young Youl Hyun5, Wookyung Chung6, Yeong Hoon Kim7, Curie Ahn2, Kyu Hun Choi1* 1 Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea, 2 Department of Internal Medicine, Seoul National University, Seoul, Korea, 3 Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea, 4 Medical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea, 5 Department of Internal Medicine, Kangbuk Samsung Medical Center, Sungkyunkwan University, Seoul, Korea, 6 Department of Internal Medicine, Gachon University, Gil Hospital, Incheon, Korea, 7 Department of Internal Medicine, Inje University, Pusan Paik Hospital, Busan, Korea OPEN ACCESS Citation: Han JS, Lee MJ, Park KS, Han SH, Yoo TH, Oh K-H, et al. (2015) Albuminuria as a Risk Factor for Anemia in Chronic Kidney Disease: Result from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). PLoS ONE 10(10): e0139747. doi:10.1371/journal. pone.0139747 Editor: Tatsuo Shimosawa, The University of Tokyo, JAPAN Received: May 22, 2015
* [email protected]
Abstract Background Anemia is a common complication among patients with chronic kidney disease (CKD), and it is associated with unfavorable clinical outcomes in patients with CKD independent of the estimated glomerular filtration rate (eGFR). We assessed the association of the urinary albumin-to-creatinine ratio (ACR) and eGFR with anemia in CKD patients.
Accepted: September 15, 2015 Published: October 2, 2015 Copyright: © 2015 Han et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper. Funding: This study was supported by the Research Program funded by the Korea Centers for Disease Control and Prevention (2011-2013-E33016-02#). The study is supervised by the CKD Advisory Committee composed of the members from the KCDC and the Korean Society of Nephrology (KSN, NCT01630486 at http://www.clinicaltrials.gov). The funders had no role in study design, data collection
Methods We conducted a cross-sectional study using baseline data from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD). Multiple regression analysis was performed to identify the independent association of albuminuria with anemia. Furthermore, odds ratios for anemia were calculated by cross-categorization of ACR and eGFR.
Results Among 1,456 patients, the mean age was 53.5 ± 12.4 years, and the mean eGFR and ACR were 51.9 ± 30.5 mL/min per 1.73 m2 and 853.2 ± 1,330.3 mg/g, respectively. Anemia was present in 644 patients (40.5%). Multivariate analysis showed that the odds ratio of anemia increased according to ACR levels, after adjusting for age, sex, eGFR, body mass index, pulse pressure, cause of CKD, use of erythropoiesis stimulating agents, serum calcium and ferritin (ACR < 30 mg/g as a reference group; 30–299 mg/g, adjusted odds ratio (OR) = 1.43, 95% confidence interval (CI) = 0.88–2.33; 300 mg/g, adjusted OR = 1.86, 95% CI = 1.12–3.10). In
PLOS ONE | DOI:10.1371/journal.pone.0139747 October 2, 2015
1 / 12
Albuminuria and Anemia in CKD
and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist.
addition, graded associations were observed in cross-categorized groups of a higher ACR and eGFR compared to the reference group with an ACR
