Skip to main content
Top
Published in: BMC Cardiovascular Disorders 1/2009

Open Access 01-12-2009 | Research article

The impact of renal insufficiency and anaemia on survival in patients with cardiovascular disease: a cohort study

Authors: Jocelyn Anderson, Liam G Glynn, John Newell, Alberto A Iglesias, Donal Reddan, Andrew W Murphy

Published in: BMC Cardiovascular Disorders | Issue 1/2009

Login to get access

Abstract

Background

The simultaneous occurrence of cardiovascular disease (CVD), kidney disease, and anaemia is associated with increased morbidity and mortality. In the community setting, little data exists about the risk associated with milder levels of anaemia when it is present concurrently with CVD and chronic kidney disease (CKD). The aim of this study was to establish the prevalence of CKD and anaemia in patients with CVD in the community and to examine whether the presence of anaemia was associated with increased morbidity and mortality.

Methods

This study was designed as a retrospective cohort study and involved a random sample of 35 general practices in the West of Ireland. A practice-based sample of 1,609 patients with established cardiovascular disease was generated in 2000/2001 and followed for five years. The primary endpoint was death from any cause. Statistical analysis involved using one-way ANOVA and Chi-squared tests for baseline data and Cox proportional-hazards models for mortality data.

Results

Of the study sample of 617 patients with blood results, 33% (n = 203) had CKD while 6% (n = 37) had CKD and anaemia. The estimated risk of death from any cause, when compared to patients with cardiovascular disease only, was almost double (HR = 1.98, 95% CI 0.99 to 3.98) for patients with both CVD and CKD and was over 4 times greater (HR = 4.33, 95% CI 1.76 to 10.68) for patients with CVD, CKD and anaemia.

Conclusion

In patients with cardiovascular disease in the community, chronic kidney disease and anaemia occur commonly. The presence of chronic kidney disease carries an increased mortality risk which increases in an additive way with the addition of anaemia. These results suggest that early primary care diagnosis and management of this high risk group may be worthwhile.
Appendix
Available only for authorised users
Literature
1.
go back to reference Glynn LG, Reddan D, Newell J, Hinde J, Buckley B, Murphy AW: Chronic kidney disease and mortality and morbidity among patients with established cardiovascular disease: a West of Ireland community-based cohort study. Nephrol Dial Transplant. 2007, 22 (9): 2586-2594. 10.1093/ndt/gfm222.CrossRefPubMed Glynn LG, Reddan D, Newell J, Hinde J, Buckley B, Murphy AW: Chronic kidney disease and mortality and morbidity among patients with established cardiovascular disease: a West of Ireland community-based cohort study. Nephrol Dial Transplant. 2007, 22 (9): 2586-2594. 10.1093/ndt/gfm222.CrossRefPubMed
2.
go back to reference Anavekar NS, McMurray JJV, Velazquez EJ, Solomon SD, Kober L, Rouleau J-L, White HD, Nordlander R, Maggioni A, Dickstein K, et al: Relation between Renal Dysfunction and Cardiovascular Outcomes after Myocardial Infarction. N Engl J Med. 2004, 351 (13): 1285-1295. 10.1056/NEJMoa041365.CrossRefPubMed Anavekar NS, McMurray JJV, Velazquez EJ, Solomon SD, Kober L, Rouleau J-L, White HD, Nordlander R, Maggioni A, Dickstein K, et al: Relation between Renal Dysfunction and Cardiovascular Outcomes after Myocardial Infarction. N Engl J Med. 2004, 351 (13): 1285-1295. 10.1056/NEJMoa041365.CrossRefPubMed
3.
go back to reference Tonelli M, Jose P, Curhan G, Sacks F, Braunwald E, Pfeffer M, Cholesterol and Recurrent Events (CARE) Trial Investigators: Proteinuria, impaired kidney function, and adverse outcomes in people with coronary disease: analysis of a previously conducted randomised trial. BMJ. 2006, 332 (7555): 1426-10.1136/bmj.38814.566019.2F.CrossRefPubMedPubMedCentral Tonelli M, Jose P, Curhan G, Sacks F, Braunwald E, Pfeffer M, Cholesterol and Recurrent Events (CARE) Trial Investigators: Proteinuria, impaired kidney function, and adverse outcomes in people with coronary disease: analysis of a previously conducted randomised trial. BMJ. 2006, 332 (7555): 1426-10.1136/bmj.38814.566019.2F.CrossRefPubMedPubMedCentral
4.
go back to reference Al Suwaidi J, Reddan DN, Williams K, Pieper KS, Harrington RA, Califf RM, Granger CB, Ohman EM, Holmes DR: Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation. 2002, 106 (8): 974-980. 10.1161/01.CIR.0000027560.41358.B3.CrossRefPubMed Al Suwaidi J, Reddan DN, Williams K, Pieper KS, Harrington RA, Califf RM, Granger CB, Ohman EM, Holmes DR: Prognostic implications of abnormalities in renal function in patients with acute coronary syndromes. Circulation. 2002, 106 (8): 974-980. 10.1161/01.CIR.0000027560.41358.B3.CrossRefPubMed
5.
go back to reference Kazory A, Ross EA: Anemia: the point of convergence or divergence for kidney disease and heart failure?. J Am Coll Cardiol. 2009, 53 (8): 639-647. 10.1016/j.jacc.2008.10.046.CrossRefPubMed Kazory A, Ross EA: Anemia: the point of convergence or divergence for kidney disease and heart failure?. J Am Coll Cardiol. 2009, 53 (8): 639-647. 10.1016/j.jacc.2008.10.046.CrossRefPubMed
6.
go back to reference Obrador GT, Roberts T, St Peter WL, Frazier E, Pereira BJ, Collins AJ: Trends in anemia at initiation of dialysis in the United States. Kidney Int. 2001, 60 (5): 1875-1884. 10.1046/j.1523-1755.2001.00002.x.CrossRefPubMed Obrador GT, Roberts T, St Peter WL, Frazier E, Pereira BJ, Collins AJ: Trends in anemia at initiation of dialysis in the United States. Kidney Int. 2001, 60 (5): 1875-1884. 10.1046/j.1523-1755.2001.00002.x.CrossRefPubMed
7.
go back to reference Silverberg DS, Wexler D, Iaina A, Steinbruch S, Wollman Y, Schwartz D: Anemia, chronic renal disease and congestive heart failure--the cardio renal anemia syndrome: the need for cooperation between cardiologists and nephrologists. Int Urol Nephrol. 2006, 38 (2): 295-310. 10.1007/s11255-006-0064-8.CrossRefPubMed Silverberg DS, Wexler D, Iaina A, Steinbruch S, Wollman Y, Schwartz D: Anemia, chronic renal disease and congestive heart failure--the cardio renal anemia syndrome: the need for cooperation between cardiologists and nephrologists. Int Urol Nephrol. 2006, 38 (2): 295-310. 10.1007/s11255-006-0064-8.CrossRefPubMed
8.
go back to reference Wright RS, Reeder GS, Herzog CA, Albright RC, Williams BA, Dvorak DL, Miller WL, Murphy JG, Kopecky SL, Jaffe AS: Acute Myocardial Infarction and Renal Dysfunction: A High-Risk Combination. Ann Intern Med. 2002, 137 (7): 563-570.CrossRefPubMed Wright RS, Reeder GS, Herzog CA, Albright RC, Williams BA, Dvorak DL, Miller WL, Murphy JG, Kopecky SL, Jaffe AS: Acute Myocardial Infarction and Renal Dysfunction: A High-Risk Combination. Ann Intern Med. 2002, 137 (7): 563-570.CrossRefPubMed
9.
go back to reference Young JB, Abraham WT, Albert NM, Gattis Stough W, Gheorghiade M, Greenberg BH, O'Connor CM, She L, Sun JL, Yancy CW, et al: Relation of low hemoglobin and anemia to morbidity and mortality in patients hospitalized with heart failure (insight from the OPTIMIZE-HF registry). Am J Cardiol. 2008, 101 (2): 223-230. 10.1016/j.amjcard.2007.07.067.CrossRefPubMed Young JB, Abraham WT, Albert NM, Gattis Stough W, Gheorghiade M, Greenberg BH, O'Connor CM, She L, Sun JL, Yancy CW, et al: Relation of low hemoglobin and anemia to morbidity and mortality in patients hospitalized with heart failure (insight from the OPTIMIZE-HF registry). Am J Cardiol. 2008, 101 (2): 223-230. 10.1016/j.amjcard.2007.07.067.CrossRefPubMed
10.
go back to reference Herzog CA, Muster HA, Li S, Collins AJ: Impact of congestive heart failure, chronic kidney disease, and anemia on survival in the Medicare population. J Card Fail. 2004, 10 (6): 467-472. 10.1016/j.cardfail.2004.03.003.CrossRefPubMed Herzog CA, Muster HA, Li S, Collins AJ: Impact of congestive heart failure, chronic kidney disease, and anemia on survival in the Medicare population. J Card Fail. 2004, 10 (6): 467-472. 10.1016/j.cardfail.2004.03.003.CrossRefPubMed
11.
go back to reference Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Borenstein J: Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol. 2002, 39 (11): 1780-1786. 10.1016/S0735-1097(02)01854-5.CrossRefPubMed Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Borenstein J: Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol. 2002, 39 (11): 1780-1786. 10.1016/S0735-1097(02)01854-5.CrossRefPubMed
12.
go back to reference McClellan WM, Flanders WD, Langston RD, Jurkovitz C, Presley R: Anemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals: a population-based study. J Am Soc Nephrol. 2002, 13 (7): 1928-1936. 10.1097/01.ASN.0000018409.45834.FA.CrossRefPubMed McClellan WM, Flanders WD, Langston RD, Jurkovitz C, Presley R: Anemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals: a population-based study. J Am Soc Nephrol. 2002, 13 (7): 1928-1936. 10.1097/01.ASN.0000018409.45834.FA.CrossRefPubMed
13.
go back to reference Rothwell PM: External validity of randomised controlled trials: "to whom do the results of this trial apply?". Lancet. 2005, 365 (9453): 82-93. 10.1016/S0140-6736(04)17670-8.CrossRefPubMed Rothwell PM: External validity of randomised controlled trials: "to whom do the results of this trial apply?". Lancet. 2005, 365 (9453): 82-93. 10.1016/S0140-6736(04)17670-8.CrossRefPubMed
14.
go back to reference Tarng DC: Cardiorenal anemia syndrome in chronic kidney disease. J Chin Med Assoc. 2007, 70 (10): 424-429. 10.1016/S1726-4901(08)70031-5.CrossRefPubMed Tarng DC: Cardiorenal anemia syndrome in chronic kidney disease. J Chin Med Assoc. 2007, 70 (10): 424-429. 10.1016/S1726-4901(08)70031-5.CrossRefPubMed
15.
go back to reference Mant J, McManus RJ, Hare R: Applicability to primary care of national clinical guidelines on blood pressure lowering for people with stroke: cross sectional study. BMJ. 2006, 332 (7542): 635-637. 10.1136/bmj.38758.600116.AE.CrossRefPubMedPubMedCentral Mant J, McManus RJ, Hare R: Applicability to primary care of national clinical guidelines on blood pressure lowering for people with stroke: cross sectional study. BMJ. 2006, 332 (7542): 635-637. 10.1136/bmj.38758.600116.AE.CrossRefPubMedPubMedCentral
16.
go back to reference Glynn LG, Reddan D, Newell J, Buckley B, Dinneen S, Murphy AW: Multimorbidity and risk among patients with established cardiovascular disease: a cohort study. BJGP. 2008, 58 (552): 488-494. 10.3399/bjgp08X319459.CrossRefPubMedPubMedCentral Glynn LG, Reddan D, Newell J, Buckley B, Dinneen S, Murphy AW: Multimorbidity and risk among patients with established cardiovascular disease: a cohort study. BJGP. 2008, 58 (552): 488-494. 10.3399/bjgp08X319459.CrossRefPubMedPubMedCentral
17.
go back to reference Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D: A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999, 130 (6): 461-470.CrossRefPubMed Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D: A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999, 130 (6): 461-470.CrossRefPubMed
18.
go back to reference National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002, 39 (2 Suppl 1): S1-266. National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002, 39 (2 Suppl 1): S1-266.
19.
go back to reference Organisation WH: Indicators and Strategies for Iron Deficiency and Anemia Programmes. Report of the WHO/UNICEF/UNU Consultation. Geneva, Switzerland. 1994 Organisation WH: Indicators and Strategies for Iron Deficiency and Anemia Programmes. Report of the WHO/UNICEF/UNU Consultation. Geneva, Switzerland. 1994
20.
go back to reference Daveluy C, Pica L, Courtemanche R, Lapointe F: Enquête sociale et de santé 1998. 2 ed. 2000, Quebec City, QC: Institut de la statistique du Québec Daveluy C, Pica L, Courtemanche R, Lapointe F: Enquête sociale et de santé 1998. 2 ed. 2000, Quebec City, QC: Institut de la statistique du Québec
21.
go back to reference Wolff JL, Starfield B, Anderson G: Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002, 62 (20): 2269-2276. 10.1001/archinte.162.20.2269.CrossRef Wolff JL, Starfield B, Anderson G: Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002, 62 (20): 2269-2276. 10.1001/archinte.162.20.2269.CrossRef
22.
go back to reference Fortin M, Lapointe L, Hudon C, Vanasse A: Multimorbidity is common to family practice Is it commonly researched?. Can Fam Physician. 2005, 51 (2): 245-PubMedCentral Fortin M, Lapointe L, Hudon C, Vanasse A: Multimorbidity is common to family practice Is it commonly researched?. Can Fam Physician. 2005, 51 (2): 245-PubMedCentral
23.
go back to reference Shlipak MG, Heidenreich PA, Noguchi H, Chertow GM, Browner WS, McClellan MB: Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients. Ann Intern Med. 2002, 137: 555-562.CrossRefPubMed Shlipak MG, Heidenreich PA, Noguchi H, Chertow GM, Browner WS, McClellan MB: Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients. Ann Intern Med. 2002, 137: 555-562.CrossRefPubMed
24.
go back to reference Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM: Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med. 2001, 345 (17): 1230-1236. 10.1056/NEJMoa010615.CrossRefPubMed Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM: Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med. 2001, 345 (17): 1230-1236. 10.1056/NEJMoa010615.CrossRefPubMed
25.
go back to reference Langston RD, Presley R, Flanders WD, McClellan WM: Renal insufficiency and anemia are independent risk factors for death among patients with acute myocardial infarction. Kidney Int. 2003, 64 (4): 1398-1405. 10.1046/j.1523-1755.2003.00200.x.CrossRefPubMed Langston RD, Presley R, Flanders WD, McClellan WM: Renal insufficiency and anemia are independent risk factors for death among patients with acute myocardial infarction. Kidney Int. 2003, 64 (4): 1398-1405. 10.1046/j.1523-1755.2003.00200.x.CrossRefPubMed
26.
go back to reference KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis. 2006, 47 (5 Suppl 3): S11-145. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis. 2006, 47 (5 Suppl 3): S11-145.
27.
go back to reference Walker AM, Schneider G, Yeaw J, Nordstrom B, Robbins S, Pettitt D: Anemia as a predictor of cardiovascular events in patients with elevated serum creatinine. J Am Soc Nephrol. 2006, 17 (8): 2293-2298. 10.1681/ASN.2005020183.CrossRefPubMed Walker AM, Schneider G, Yeaw J, Nordstrom B, Robbins S, Pettitt D: Anemia as a predictor of cardiovascular events in patients with elevated serum creatinine. J Am Soc Nephrol. 2006, 17 (8): 2293-2298. 10.1681/ASN.2005020183.CrossRefPubMed
28.
go back to reference Culleton BF, Manns BJ, Zhang J, Tonelli M, Klarenbach S, Hemmelgarn BR: Impact of anemia on hospitalization and mortality in older adults. Blood. 2006, 107 (10): 3841-3846. 10.1182/blood-2005-10-4308.CrossRefPubMed Culleton BF, Manns BJ, Zhang J, Tonelli M, Klarenbach S, Hemmelgarn BR: Impact of anemia on hospitalization and mortality in older adults. Blood. 2006, 107 (10): 3841-3846. 10.1182/blood-2005-10-4308.CrossRefPubMed
29.
go back to reference Vlagopoulos PT, Tighiouart H, Weiner DE, Griffith J, Pettitt D, Salem DN, Levey AS, Sarnak MJ: Anemia as a risk factor for cardiovascular disease and all-cause mortality in diabetes: the impact of chronic kidney disease. J Am Soc Nephrol. 2005, 16 (11): 3403-3410. 10.1681/ASN.2005030226.CrossRefPubMed Vlagopoulos PT, Tighiouart H, Weiner DE, Griffith J, Pettitt D, Salem DN, Levey AS, Sarnak MJ: Anemia as a risk factor for cardiovascular disease and all-cause mortality in diabetes: the impact of chronic kidney disease. J Am Soc Nephrol. 2005, 16 (11): 3403-3410. 10.1681/ASN.2005030226.CrossRefPubMed
30.
go back to reference Zakai NA, Katz R, Hirsch C, Shlipak MG, Chaves PH, Newman AB, Cushman M: A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort: the Cardiovascular Health Study. Arch Intern Med. 2005, 165 (19): 2214-2220. 10.1001/archinte.165.19.2214.CrossRefPubMed Zakai NA, Katz R, Hirsch C, Shlipak MG, Chaves PH, Newman AB, Cushman M: A prospective study of anemia status, hemoglobin concentration, and mortality in an elderly cohort: the Cardiovascular Health Study. Arch Intern Med. 2005, 165 (19): 2214-2220. 10.1001/archinte.165.19.2214.CrossRefPubMed
31.
go back to reference Drueke T, Locatelli F, Clyne N, Eckardt K, Macdougall I, Tsakiris D, Burger H, Scherhag A, Investigators C: Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med. 2006, 355: 2071-2084. 10.1056/NEJMoa062276.CrossRefPubMed Drueke T, Locatelli F, Clyne N, Eckardt K, Macdougall I, Tsakiris D, Burger H, Scherhag A, Investigators C: Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med. 2006, 355: 2071-2084. 10.1056/NEJMoa062276.CrossRefPubMed
32.
go back to reference Ghali JK, Anand IS, Abraham WT, Fonarow GC, Greenberg B, Krum H, Massie BM, Wasserman SM, Trotman ML, Sun Y, et al: Randomized double-blind trial of darbepoetin alfa in patients with symptomatic heart failure and anemia. Circulation. 2008, 117 (4): 526-535. 10.1161/CIRCULATIONAHA.107.698514.CrossRefPubMed Ghali JK, Anand IS, Abraham WT, Fonarow GC, Greenberg B, Krum H, Massie BM, Wasserman SM, Trotman ML, Sun Y, et al: Randomized double-blind trial of darbepoetin alfa in patients with symptomatic heart failure and anemia. Circulation. 2008, 117 (4): 526-535. 10.1161/CIRCULATIONAHA.107.698514.CrossRefPubMed
33.
go back to reference Singh A, Szczech L, Tang K, Barnhart H, Sapp S, Wolfson M, Reddan D, Investigators C: Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006, 355: 2085-2098. 10.1056/NEJMoa065485.CrossRefPubMed Singh A, Szczech L, Tang K, Barnhart H, Sapp S, Wolfson M, Reddan D, Investigators C: Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006, 355: 2085-2098. 10.1056/NEJMoa065485.CrossRefPubMed
34.
go back to reference Palazzuoli A, Silverberg D, Iovine F, Capobianco S, Giannotti G, Calabro A, Campagna SM, Nuti R: Erythropoietin improves anemia exercise tolerance and renal function and reduces B-type natriuretic peptide and hospitalization in patients with heart failure and anemia. Am Heart J. 2006, 152 (6): e1099-1015. 10.1016/j.ahj.2006.08.005.CrossRef Palazzuoli A, Silverberg D, Iovine F, Capobianco S, Giannotti G, Calabro A, Campagna SM, Nuti R: Erythropoietin improves anemia exercise tolerance and renal function and reduces B-type natriuretic peptide and hospitalization in patients with heart failure and anemia. Am Heart J. 2006, 152 (6): e1099-1015. 10.1016/j.ahj.2006.08.005.CrossRef
35.
go back to reference Toblli JE, Lombrana A, Duarte P, Di Gennaro F: Intravenous iron reduces NT-pro-brain natriuretic peptide in anemic patients with chronic heart failure and renal insufficiency. J Am Coll Cardiol. 2007, 50 (17): 1657-1665. 10.1016/j.jacc.2007.07.029.CrossRefPubMed Toblli JE, Lombrana A, Duarte P, Di Gennaro F: Intravenous iron reduces NT-pro-brain natriuretic peptide in anemic patients with chronic heart failure and renal insufficiency. J Am Coll Cardiol. 2007, 50 (17): 1657-1665. 10.1016/j.jacc.2007.07.029.CrossRefPubMed
36.
go back to reference Mix TC, Brenner RM, Cooper ME, de Zeeuw D, Ivanovich P, Levey AS, McGill JB, McMurray JJ, Parfrey PS, Parving HH, et al: Rationale--Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT): evolving the management of cardiovascular risk in patients with chronic kidney disease. Am Heart J. 2005, 149 (3): 408-413. 10.1016/j.ahj.2004.09.047.CrossRefPubMed Mix TC, Brenner RM, Cooper ME, de Zeeuw D, Ivanovich P, Levey AS, McGill JB, McMurray JJ, Parfrey PS, Parving HH, et al: Rationale--Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT): evolving the management of cardiovascular risk in patients with chronic kidney disease. Am Heart J. 2005, 149 (3): 408-413. 10.1016/j.ahj.2004.09.047.CrossRefPubMed
37.
go back to reference van Veldhuisen DJ, McMurray JJ: Are erythropoietin stimulating proteins safe and efficacious in heart failure? Why we need an adequately powered randomised outcome trial. Eur J Heart Fail. 2007, 9 (2): 110-112. 10.1016/j.ejheart.2007.01.004.CrossRefPubMed van Veldhuisen DJ, McMurray JJ: Are erythropoietin stimulating proteins safe and efficacious in heart failure? Why we need an adequately powered randomised outcome trial. Eur J Heart Fail. 2007, 9 (2): 110-112. 10.1016/j.ejheart.2007.01.004.CrossRefPubMed
38.
go back to reference Levin A, Hemmelgarn B, Culleton B, Tobe S, McFarlane P, Ruzicka M, Burns K, Manns B, White C, Madore F, et al: Guidelines for the management of chronic kidney disease. Cmaj. 2008, 179 (11): 1154-1162.CrossRefPubMedPubMedCentral Levin A, Hemmelgarn B, Culleton B, Tobe S, McFarlane P, Ruzicka M, Burns K, Manns B, White C, Madore F, et al: Guidelines for the management of chronic kidney disease. Cmaj. 2008, 179 (11): 1154-1162.CrossRefPubMedPubMedCentral
39.
go back to reference Locatelli F, Aljama P, Barany P, Canaud B, Carrera F, Eckardt KU, Horl WH, Macdougal IC, Macleod A, Wiecek A, et al: Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure. Nephrol Dial Transplant. 2004, 19 (Suppl 2): ii1-47. 10.1093/ndt/gfh1032.PubMed Locatelli F, Aljama P, Barany P, Canaud B, Carrera F, Eckardt KU, Horl WH, Macdougal IC, Macleod A, Wiecek A, et al: Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure. Nephrol Dial Transplant. 2004, 19 (Suppl 2): ii1-47. 10.1093/ndt/gfh1032.PubMed
40.
go back to reference Basile JN: Recognizing the link between CKD and CVD in the primary care setting: accurate and early diagnosis for timely and appropriate intervention. South Med J. 2007, 100 (5): 499-505.CrossRefPubMed Basile JN: Recognizing the link between CKD and CVD in the primary care setting: accurate and early diagnosis for timely and appropriate intervention. South Med J. 2007, 100 (5): 499-505.CrossRefPubMed
41.
go back to reference Fox CH, Swanson A, Kahn LS, Glaser K, Murray BM: Improving chronic kidney disease care in primary care practices: an upstate New York practice-based research network (UNYNET) study. J Am Board Fam Med. 2008, 21 (6): 522-530. 10.3122/jabfm.2008.06.080042.CrossRefPubMed Fox CH, Swanson A, Kahn LS, Glaser K, Murray BM: Improving chronic kidney disease care in primary care practices: an upstate New York practice-based research network (UNYNET) study. J Am Board Fam Med. 2008, 21 (6): 522-530. 10.3122/jabfm.2008.06.080042.CrossRefPubMed
42.
go back to reference Cannata-Andia JB, Locatelli F, Zoccali C: The First European Renal Association-European Dialysis and Transplant Association CKD Anaemia Physician Behaviours Survey: key findings. J NEPHROL. 2008, 21 (2): 190-196.PubMed Cannata-Andia JB, Locatelli F, Zoccali C: The First European Renal Association-European Dialysis and Transplant Association CKD Anaemia Physician Behaviours Survey: key findings. J NEPHROL. 2008, 21 (2): 190-196.PubMed
Metadata
Title
The impact of renal insufficiency and anaemia on survival in patients with cardiovascular disease: a cohort study
Authors
Jocelyn Anderson
Liam G Glynn
John Newell
Alberto A Iglesias
Donal Reddan
Andrew W Murphy
Publication date
01-12-2009
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2009
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/1471-2261-9-51

Other articles of this Issue 1/2009

BMC Cardiovascular Disorders 1/2009 Go to the issue