Skip to main content
Top
Published in: Clinical and Experimental Nephrology 6/2009

01-12-2009 | Original Article

Prevalence of anemia according to stage of chronic kidney disease in a large screening cohort of Japanese

Authors: Kentaro Kohagura, Nozomi Tomiyama, Kozen Kinjo, Shuichi Takishita, Kunitoshi Iseki

Published in: Clinical and Experimental Nephrology | Issue 6/2009

Login to get access

Abstract

Background

The prevalence of chronic kidney disease (CKD) is high in developed countries, including Japan. However, little is known about the prevalence of anemia according to the estimated glomerular filtration rate (eGFR) among Japanese.

Methods

We studied screenees on the Okinawa General Health Maintenance Association (OGHMA) registry in 1993 (N = 94,602; 54,848 women and 39,754 men) who had both serum creatinine and hematocrit data. Anemia was defined as follows: hematocrit level <40% in men, <32% in women aged <50 years, and <35% in women aged ≥50 years. GFR was estimated using a new Japanese equation: eGFR (ml/min per 1.73 m2) = 194 × serum creatinine1.094 × age0.287 × 0.739 (if female).

Results

The prevalence of anemia clearly increased as CKD progressed below an eGFR of 60 ml/min per 1.73 m2 in both genders. Logistic analysis adjusted with body mass index and older age (≥70 years) revealed that the odds ratio for complications of anemia was significantly increased below an eGFR of 45 ml/min per 1.73 m2 in women and 90 ml/min per 1.73 m2 in men. The association of lower kidney function with anemia was found to be more prevalent: adjusted odds ratio ≥2.0, from approximately 50 ml/min per 1.73 m2.

Conclusion

The present study suggested that there might be as many as 1,000,000 people with CKD stage 3–5 complicated with anemia in Japan.
Literature
1.
go back to reference Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;51:1296–305.CrossRef Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;51:1296–305.CrossRef
2.
go back to reference Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003;108:2154–69.CrossRefPubMed Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003;108:2154–69.CrossRefPubMed
3.
go back to reference Ninomiya T, Kiyohara Y, Kubo M, Tanizaki Y, Doi Y, Okubo K, et al. Chronic kidney disease and cardiovascular disease in a general Japanese population: the Hisayama study. Kidney Int. 2005;68:228–36.CrossRefPubMed Ninomiya T, Kiyohara Y, Kubo M, Tanizaki Y, Doi Y, Okubo K, et al. Chronic kidney disease and cardiovascular disease in a general Japanese population: the Hisayama study. Kidney Int. 2005;68:228–36.CrossRefPubMed
4.
go back to reference Sarnak MJ, Tighiouart H, Manjunath G, MacLeod B, Griffith J, Salem D, et al. Anemia as a risk factor for cardiovascular disease in the atherosclerosis risk in communities (ARIC) study. J Am Coll Cardiol. 2002;40:27–33.CrossRefPubMed Sarnak MJ, Tighiouart H, Manjunath G, MacLeod B, Griffith J, Salem D, et al. Anemia as a risk factor for cardiovascular disease in the atherosclerosis risk in communities (ARIC) study. J Am Coll Cardiol. 2002;40:27–33.CrossRefPubMed
5.
go back to reference Jurkovitz CT, Abramson JL, Vaccarino LV, Weintraub WS, McClellan WM. Association of high serum creatinine and anemia increases the risk of coronary events: results from the prospective community-based atherosclerosis risk in communities (ARIC) study. J Am Soc Nephrol. 2003;14:2919–25.CrossRefPubMed Jurkovitz CT, Abramson JL, Vaccarino LV, Weintraub WS, McClellan WM. Association of high serum creatinine and anemia increases the risk of coronary events: results from the prospective community-based atherosclerosis risk in communities (ARIC) study. J Am Soc Nephrol. 2003;14:2919–25.CrossRefPubMed
6.
go back to reference Muntner P, He J, Astor BC, Folsom AR, Coresh J. Traditional and nontraditional risk factors predict coronary heart disease in chronic kidney disease: results from the atherosclerosis risk in communities study. J Am Soc Nephrol. 2005;16:529–38.CrossRefPubMed Muntner P, He J, Astor BC, Folsom AR, Coresh J. Traditional and nontraditional risk factors predict coronary heart disease in chronic kidney disease: results from the atherosclerosis risk in communities study. J Am Soc Nephrol. 2005;16:529–38.CrossRefPubMed
7.
go back to reference Leeder SR, Mitchell P, Liew G, Rochtchina E, Smith W, Wang JJ. Low hemoglobin, chronic kidney disease, and risk for coronary heart disease-related death: the Blue Mountains eye study. J Am Soc Nephrol. 2006;17:279–84.CrossRefPubMed Leeder SR, Mitchell P, Liew G, Rochtchina E, Smith W, Wang JJ. Low hemoglobin, chronic kidney disease, and risk for coronary heart disease-related death: the Blue Mountains eye study. J Am Soc Nephrol. 2006;17:279–84.CrossRefPubMed
8.
go back to reference Abramson JL, Jurkovitz CT, Vaccarino V, Weintraub WS, McClellan W. Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: the ARIC Study. Kidney Int. 2003;64:610–5.CrossRefPubMed Abramson JL, Jurkovitz CT, Vaccarino V, Weintraub WS, McClellan W. Chronic kidney disease, anemia, and incident stroke in a middle-aged, community-based population: the ARIC Study. Kidney Int. 2003;64:610–5.CrossRefPubMed
9.
go back to reference Silverberg D, Wexler D, Blum M, Wollman Y, Iaina A. The cardio-renal anaemia syndrome: does it exist? Nephrol Dial Transplant. 2003;18(Suppl 8):viii7–12.PubMed Silverberg D, Wexler D, Blum M, Wollman Y, Iaina A. The cardio-renal anaemia syndrome: does it exist? Nephrol Dial Transplant. 2003;18(Suppl 8):viii7–12.PubMed
10.
go back to reference Coresh J, Byrd-Holt D, Astor BC, Briggs JP, Eggers PW, Lacher DA, et al. Chronic kidney disease awareness, prevalence, and trends among US adults, 1999 to 2000. J Am Soc Nephrol. 2005;16:180–8.CrossRefPubMed Coresh J, Byrd-Holt D, Astor BC, Briggs JP, Eggers PW, Lacher DA, et al. Chronic kidney disease awareness, prevalence, and trends among US adults, 1999 to 2000. J Am Soc Nephrol. 2005;16:180–8.CrossRefPubMed
11.
go back to reference Meisinger C, Doring A, Lowel H. Chronic kidney disease and risk of incident myocardial infarction and all-cause and cardiovascular disease mortality in middle-aged men and women from the general population. Eur Heart J. 2006;27:1245–50.CrossRefPubMed Meisinger C, Doring A, Lowel H. Chronic kidney disease and risk of incident myocardial infarction and all-cause and cardiovascular disease mortality in middle-aged men and women from the general population. Eur Heart J. 2006;27:1245–50.CrossRefPubMed
12.
go back to reference Imai E, Horio M, Iseki K, Yamagata K, Watanabe T, Hara S, et al. Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient. Clin Exp Nephrol. 2007;11:156–63.CrossRefPubMed Imai E, Horio M, Iseki K, Yamagata K, Watanabe T, Hara S, et al. Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient. Clin Exp Nephrol. 2007;11:156–63.CrossRefPubMed
13.
go back to reference Chen J, Wildman RP, Gu D, Kusek JW, Spruill M, Reynolds K, et al. Revalence of decreased kidney function in Chinese adults aged 35 to 74 years. Kidney Int. 2005;68:2837–45.CrossRefPubMed Chen J, Wildman RP, Gu D, Kusek JW, Spruill M, Reynolds K, et al. Revalence of decreased kidney function in Chinese adults aged 35 to 74 years. Kidney Int. 2005;68:2837–45.CrossRefPubMed
14.
go back to reference Fehr T, Ammann P, Garzoni D, Korte W, Fierz W, Rickli H, et al. Interpretation of erythropoietin levels in patients with various degrees of renal insufficiency and anemia. Kidney Int. 2004;66:1206–11.CrossRefPubMed Fehr T, Ammann P, Garzoni D, Korte W, Fierz W, Rickli H, et al. Interpretation of erythropoietin levels in patients with various degrees of renal insufficiency and anemia. Kidney Int. 2004;66:1206–11.CrossRefPubMed
15.
go back to reference Hsu CY, McCulloch CE, Curhan GC. Epidemiology of anemia associated with chronic renal insufficiency among adults in the United States: results from the Third National Health and Nutrition Examination Survey. J Am Soc Nephrol. 2002;13:504–10.CrossRefPubMed Hsu CY, McCulloch CE, Curhan GC. Epidemiology of anemia associated with chronic renal insufficiency among adults in the United States: results from the Third National Health and Nutrition Examination Survey. J Am Soc Nephrol. 2002;13:504–10.CrossRefPubMed
16.
go back to reference Astor BC, Muntner P, Levin A, Eustace JA, Coresh J. Association of kidney function with anemia: the Third National Health and Nutrition Examination Survey (1988–1994). Arch Intern Med. 2002;162:1401–8.CrossRefPubMed Astor BC, Muntner P, Levin A, Eustace JA, Coresh J. Association of kidney function with anemia: the Third National Health and Nutrition Examination Survey (1988–1994). Arch Intern Med. 2002;162:1401–8.CrossRefPubMed
17.
go back to reference Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis. 2003;41:1–12.CrossRefPubMed Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis. 2003;41:1–12.CrossRefPubMed
18.
go back to reference Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised Equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009; (in press). Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised Equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009; (in press).
19.
go back to reference Iseki K, Kinjo K, Iseki C, Takishita S. Relationship between predicted creatinine clearance and proteinuria and the risk of developing ESRD in Okinawa, Japan. Am J Kidney Dis. 2004;441:806–14.CrossRef Iseki K, Kinjo K, Iseki C, Takishita S. Relationship between predicted creatinine clearance and proteinuria and the risk of developing ESRD in Okinawa, Japan. Am J Kidney Dis. 2004;441:806–14.CrossRef
20.
go back to reference Gejyo F, Saito A, Akizawa T, Akiba T, Sakai T, Suzuki M, et al. 2004 Japanese Society for dialysis therapy guidelines for renal anemia in chronic hemodialysis patients. Ther Apher Dial. 2004;37:1737–63. Gejyo F, Saito A, Akizawa T, Akiba T, Sakai T, Suzuki M, et al. 2004 Japanese Society for dialysis therapy guidelines for renal anemia in chronic hemodialysis patients. Ther Apher Dial. 2004;37:1737–63.
21.
go back to reference NKF-DOQI clinical practice guidelines for the treatment of anemia of chronic renal failure. National Kidney Foundation-Dialysis Outcomes Quality Initiative, Am J Kidney Dis. 1997;30(4 Suppl 3):S192–240. NKF-DOQI clinical practice guidelines for the treatment of anemia of chronic renal failure. National Kidney Foundation-Dialysis Outcomes Quality Initiative, Am J Kidney Dis. 1997;30(4 Suppl 3):S192–240.
23.
go back to reference Ble A, Fink JC, Woodman RC, Klausner MA, Windham BG, Guralnik JM, et al. Renal function, erythropoietin, and anemia of older persons: the InCHIANTI study. Arch Intern Med. 2005;165:2222–7.CrossRefPubMed Ble A, Fink JC, Woodman RC, Klausner MA, Windham BG, Guralnik JM, et al. Renal function, erythropoietin, and anemia of older persons: the InCHIANTI study. Arch Intern Med. 2005;165:2222–7.CrossRefPubMed
24.
go back to reference Imai E, Horio M, Yamagata K, Iseki K, Watanabe T, Hara S, et al. Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient. Hypertens Res. 2008;31:433–41.CrossRefPubMed Imai E, Horio M, Yamagata K, Iseki K, Watanabe T, Hara S, et al. Prevalence of chronic kidney disease (CKD) in the Japanese general population predicted by the MDRD equation modified by a Japanese coefficient. Hypertens Res. 2008;31:433–41.CrossRefPubMed
25.
go back to reference Hsu CY, Bates DW, Kuperman GJ, Curhan GC. Relationship between hematocrit and renal function in men and women. Kidney Int. 2001;59:725–31.CrossRefPubMed Hsu CY, Bates DW, Kuperman GJ, Curhan GC. Relationship between hematocrit and renal function in men and women. Kidney Int. 2001;59:725–31.CrossRefPubMed
26.
go back to reference Iseki K, Nakai S, Shinzato T, Nagura Y, Akiba T. Increasing gender difference in the incidence of chronic dialysis therapy in Japan. Ther Apher Dial. 2005;9:407–11.CrossRefPubMed Iseki K, Nakai S, Shinzato T, Nagura Y, Akiba T. Increasing gender difference in the incidence of chronic dialysis therapy in Japan. Ther Apher Dial. 2005;9:407–11.CrossRefPubMed
27.
go back to reference Brockenbrough AT, Dittrich MO, Page ST, Smith T, Stivelman JC, Bremner WJ. Transdermal androgen therapy to augment EPO in the treatment of anemia of chronic renal disease. Am J Kidney Dis. 2006;47:251–62.CrossRefPubMed Brockenbrough AT, Dittrich MO, Page ST, Smith T, Stivelman JC, Bremner WJ. Transdermal androgen therapy to augment EPO in the treatment of anemia of chronic renal disease. Am J Kidney Dis. 2006;47:251–62.CrossRefPubMed
28.
go back to reference Mukundan H, Kanagy NL, Resta TC. 17-beta estradiol attenuates hypoxic induction of HIF-1alpha and erythropoietin in Hep3B cells. J Cardiovasc Pharmacol. 2004;44:93–100.CrossRefPubMed Mukundan H, Kanagy NL, Resta TC. 17-beta estradiol attenuates hypoxic induction of HIF-1alpha and erythropoietin in Hep3B cells. J Cardiovasc Pharmacol. 2004;44:93–100.CrossRefPubMed
29.
go back to reference Silverberg DS, Wexler D, Blum M, Schwartz D, Wollman Y, Iaina A. Erythropoietin should be part of congestive heart failure management. Kidney Int Suppl. 2003;87:S40–7.CrossRef Silverberg DS, Wexler D, Blum M, Schwartz D, Wollman Y, Iaina A. Erythropoietin should be part of congestive heart failure management. Kidney Int Suppl. 2003;87:S40–7.CrossRef
30.
go back to reference Drueke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, et al. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med. 2006;355:2071–84.CrossRefPubMed Drueke TB, Locatelli F, Clyne N, Eckardt KU, Macdougall IC, Tsakiris D, et al. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med. 2006;355:2071–84.CrossRefPubMed
31.
go back to reference Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006;355:2085–98.CrossRefPubMed Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006;355:2085–98.CrossRefPubMed
32.
go back to reference Phrommintikul A, Haas SJ, Elsik M, Krum H. Mortality and target haemoglobin concentrations in anaemic patients with chronic kidney disease treated with erythropoietin: a meta-analysis. Lancet. 2007;369:381–8.CrossRefPubMed Phrommintikul A, Haas SJ, Elsik M, Krum H. Mortality and target haemoglobin concentrations in anaemic patients with chronic kidney disease treated with erythropoietin: a meta-analysis. Lancet. 2007;369:381–8.CrossRefPubMed
33.
go back to reference Chaves PH, Ashar B, Guralnik JM, Fried LP. Looking at the relationship between hemoglobin concentration and prevalent mobility difficulty in older women. Should the criteria currently used to define anemia in older people be reevaluated? J Am Geriatr Soc. 2002;50:1257–64.CrossRefPubMed Chaves PH, Ashar B, Guralnik JM, Fried LP. Looking at the relationship between hemoglobin concentration and prevalent mobility difficulty in older women. Should the criteria currently used to define anemia in older people be reevaluated? J Am Geriatr Soc. 2002;50:1257–64.CrossRefPubMed
Metadata
Title
Prevalence of anemia according to stage of chronic kidney disease in a large screening cohort of Japanese
Authors
Kentaro Kohagura
Nozomi Tomiyama
Kozen Kinjo
Shuichi Takishita
Kunitoshi Iseki
Publication date
01-12-2009
Publisher
Springer Japan
Published in
Clinical and Experimental Nephrology / Issue 6/2009
Print ISSN: 1342-1751
Electronic ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-009-0197-z

Other articles of this Issue 6/2009

Clinical and Experimental Nephrology 6/2009 Go to the issue