Open Access Open Badges Research article

The development of anemia is associated to poor prognosis in NKF/KDOQI stage 3 chronic kidney disease

José Portolés11089*, Jose Luis Gorriz28, Esther Rubio189, Fernando de Alvaro38, Florencio García48, Vicente Alvarez-Chivas589, Pedro Aranda68, Alberto Martinez-Castelao78 and NADIR-3 Study Group

Author Affiliations

1 Nephrology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain

2 Nephrology Department, Hospital Universitario Dr. Peset, Valencia, Spain

3 Hospital Infanta Sofia, San Sebastian de los Reyes, Madrid, Spain

4 Nephrology Department, Hospital Universitario Doce de Octubre, Madrid, Spain

5 Nephrology Department, Hospital Universitario La Princesa, Madrid, Spain

6 Nephrology Department,Hospital Carlos Haya, Malaga, Spain

7 Nephrology Department, Hospital Universitario Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

8 Spanish Group for the study of Diabetic Nephropathy, GEENDIAB-SEN, Barcelona, Spain

9 Spanish Renal Research Network, REDInRen Red 6/0016 (Instituto Salud Carlos III), Madrid, Spain

10 Servicio de Nefrología, Hospital Universitario Puerta de Hierro, C/ Manuel de Falla 1, Majadahonda, Madrid, 28229, Spain

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BMC Nephrology 2013, 14:2  doi:10.1186/1471-2369-14-2

Published: 7 January 2013



Anemia is a common condition in CKD that has been identified as a cardiovascular (CV) risk factor in end-stage renal disease, constituting a predictor of low survival. The aim of this study was to define the onset of anemia of renal origin and its association with the evolution of kidney disease and clinical outcomes in stage 3 CKD (CKD-3).


This epidemiological, prospective, multicenter, 3-year study included 439 CKD-3 patients. The origin of nephropathy and comorbidity (Charlson score: 3.2) were recorded. The clinical characteristics of patients that developed anemia according to EBPG guidelines were compared with those that did not, followed by multivariate logistic regression, Kaplan-Meier curves and ROC curves to investigate factors associated with the development of renal anemia.


During the 36-month follow-up period, 50% reached CKD-4 or 5, and approximately 35% were diagnosed with anemia (85% of renal origin). The probability of developing renal anemia was 0.12, 0.20 and 0.25 at 1, 2 and 3 years, respectively. Patients that developed anemia were mainly men (72% anemic vs. 69% non-anemic). The mean age was 68 vs. 65.5 years and baseline proteinuria was 0.94 vs. 0.62 g/24h (anemic vs. non anemic, respectively). Baseline MDRD values were 36 vs. 40 mL/min and albumin 4.1 vs. 4.3 g/dL; reduction in MDRD was greater in those that developed anemia (6.8 vs. 1.6 mL/min/1.73 m2/3 years). These patients progressed earlier to CKD-4 or 5 (18 vs. 28 months), with a higher proportion of hospitalizations (31 vs. 16%), major CV events (16 vs. 7%), and higher mortality (10 vs. 6.6%) than those without anemia. Multivariate logistic regression indicated a significant association between baseline hemoglobin (OR=0.35; 95% CI: 0.24-0.28), glomerular filtration rate (OR=0.96; 95% CI: 0.93-0.99), female (OR=0.19; 95% CI: 0.10-0.40) and the development of renal anemia.


Renal anemia is associated with a more rapid evolution to CKD-4, and a higher risk of CV events and hospitalization in non-dialysis-dependent CKD patients. This suggests that special attention should be paid to anemic CKD-3 patients.

Chronic kidney disease; Anemia; Cardiovascular risk; Non-dialysis CKD patients; Epidemiology