Association of Anemia with Cardiovascular disease in patients with Diabetic Nephropathy with normal GFR

Association of Anemia with Cardiovascular disease in patients with Diabetic Nephropathy with normal GFR

Loading document ...
Page
of
Loading page ...

Author(s)

Author(s): Khurshid Ahmad Khan, Professor Javed Akram

Download Full PDF Read Complete Article

791 1228 134-152 Volume 1 - Dec 2012

Abstract

Background: Anemia is recognized as an independent cardiovascular disease (CVD) risk factor in diabetic patients with end stage renal disease. However, it is not known whether anemia associated with early diabetic nephropathy increases CVD risk.Objective: To assess the effect of anemia on CVD risk in patients with Stage 1 chronic kidney disease (CKD).Materials and Methods: Cross sectional analysis of 2,502 diabetic patients with stage 1 CKD. Demographic, clinical and laboratory data were collected from two teaching hospitals affiliated with medical university in Lahore, Pakistan.Results: Of the 2,502 diabetic patients examined, 96% had type 2 diabetes. Age (years) = 64.2 ± 0.2, BMI= 29.6±0.2, duration of diabetes (years) = 9.3± 0.17, Hemoglobin A1C (A1C) % =7.8±0.04. Males represented 83.2% of the cohort.The CVD group included 909 (36.3%) of the total cohort and had a significantly lower mean serum hemoglobin (g/dl) (12.9±0.05 Vs 13.4±0.04, p <0.01), and hematocrit (%) (38.8±0.19 Vs 40.04±0.17, p<0.01), compared to those without CVD events. Both groups had stage I diabetic nephropathy with urinary albumin >30 mg/gm creatinine and normal GFR (>90 ml/min/1.73m2). Using the National Kidney Foundation (NKF) threshold Hb of 12 g/dl for initiation of work up for anemia in chronic kidney disease, in our logistic regression model the odds ration (OR) for CVD in patients with Hb<12 g/dl was 1.94 (95% CI= 1.6-2.3, p <0.01). After adjusting for CVD risk factors, anemia remained a significant predictor for CVD events OR=1.64 (95%CI = 1.3-2.0, p<0.01). We also examined Hb as a continuous variable and found that; for each unit decrease in hemoglobin, the odds of CVD increases, OR =1.21 (1.14-1.28, p <0.01)

References

  1. Grundy SM, Benjamin IJ, Burke GL, et al. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 1999; 100:1134-46
  2. McFarlane SI, Banerji M, Sowers JR. Insulin resistance and cardiovascular disease. J Clin Endocrinol Metab 2001; 86:713-8
  3. Levin A, Djurdjev O, Barrett B, et al. Cardiovascular disease in patients with chronic kidney disease: getting to the heart of the matter. Am J Kidney Dis 2001; 38:1398-407
  4. Culleton BF, Larson MG, Wilson PW, Evans JC, Parfrey PS, Levy D. Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency. Kidney Int 1999; 56:2214-9
  5. Agodoa L. United States Renal Data System (USRDS). Nefrologia 2000; 20 Suppl 5:13-6.
  6. Foley R. Cardiac disease in diabetic patients with renal disease. Acta Diabetol 2002; 39 Suppl 1:S9-14
  7. McFarlane SI, Jacober SJ, Winer N, et al. Control of cardiovascular risk factors in patients with diabetes and hypertension at urban academic medical centers. Diabetes Care 2002; 25:718-23
  8. Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. Jama 2004; 291:335-42
  9. Levin A, Singer J, Thompson CR, Ross H, Lewis M. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am J Kidney Dis 1996; 27:347-54
  10. Portoles J, Torralbo A, Martin P, Rodrigo J, Herrero JA, Barrientos A. Cardiovascular effects of recombinant human erythropoietin in predialysis patients. Am J Kidney Dis 1997; 29:541-8
  11. Hayashi T, Suzuki A, Shoji T, et al. Cardiovascular effect of normalizing the hematocrit level during erythropoietin therapy in predialysis patients with chronic renal failure. Am J Kidney Dis 2000; 35:250-6
  12. Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. The impact of anemia on cardiomyopathy, morbidity, and and mortality in end-stage renal disease. Am J Kidney Dis 1996; 28:53-61
  13. Collins AJ, Li S, St Peter W, et al. Death, hospitalization, and economic associations among incident hemodialysis patients with hematocrit values of 36 to 39%. J Am Soc Nephrol 2001; 12:2465-73
  14. London GM, Pannier B, Guerin AP, et al. Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study. J Am Soc Nephrol 2001; 12:2759-67
  15. Besarab A, Bolton WK, Browne JK, et al. The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N Engl J Med 1998; 339:584-90
  16. Pereira AA, Sarnak MJ. Anemia as a risk factor for cardiovascular disease. Kidney Int Suppl 2003:S32-9
  17. Sarnak MJ, Tighiouart H, Manjunath G, 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
  18. Thomas MC, MacIsaac RJ, Tsalamandris C, Power D, Jerums G. Unrecognized anemia in patients with diabetes: a cross-sectional survey. Diabetes Care 2003; 26:1164-9
  19. Stevens PE, O'Donoghue DJ, Lameire NR. Anaemia in patients with diabetes: unrecognised, undetected and untreated? Curr Med Res Opin 2003; 19:395-401
  20. 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
  21. McFarlane SI, Salifu MO, Makaryus J, Sowers JR. Anemia and cardiovascular disease in diabetic nephropathy. Curr Diab Rep 2006; 6:213-8
  22. Sorlie PD, Garcia-Palmieri MR, Costas R, Jr., Havlik RJ. Hematocrit and risk of coronary heart disease: the Puerto Rico Health Program. Am Heart J 1981; 101:456-61
  23. Gagnon DR, Zhang TJ, Brand FN, Kannel WB. Hematocrit and the risk of cardiovascular disease--the Framingham study: a 34-year follow-up. Am Heart J 1994; 127:674-82
  24. Carter C, McGee D, Reed D, Yano K, Stemmermann G. Hematocrit and the risk of coronary heart disease: the Honolulu Heart Program. Am Heart J 1983; 105:674-9
  25. Mozaffarian D, Nye R, Levy WC. Anemia predicts mortality in severe heart failure: the prospective randomized amlodipine survival evaluation (PRAISE). J Am Coll Cardiol 2003; 41:1933-9
  26. 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; 13:1928-36
  27. O'Meara E, Clayton T, McEntegart MB, et al. Clinical correlates and consequences of anemia in a broad spectrum of patients with heart failure: results of the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) Program. Circulation 2006; 113:986-94
  28. Duke M, Abelmann WH. The hemodynamic response to chronic anemia. Circulation 1969; 39:503-15
  29. Portoles J, Torralbo A, Martin P, Rodrigo J, Herrero JA, Barrientos A. Cardiovascular effects of recombinant human erythropoietin in predialysis patients. Am J Kidney Dis 1997; 29:541-8
  30. Nissenson AR, Nimer SD, Wolcott DL. Recombinant human erythropoietin and renal anemia: molecular biology, clinical efficacy, and nervous system effects. Ann Intern Med 1991; 114:402-16
  31. Tramontano AF, Muniyappa R, Black AD, et al. Erythropoietin protects cardiac myocytes from hypoxia-induced apoptosis through an Akt-dependent pathway. Biochem Biophys Res Commun 2003; 308:990-4
  32. Andreotti F, Coluzzi G, Cecchetti S, et al. Reduced CD34+, renal anemia, and adverse outcomes. Am Heart J 2006; 152:e21
  33. Andreotti F, Coluzzi G, Lavorgna A, et al. Relation between nitric oxide metabolites and haemoglobin concentrations in patients with ischaemic heart disease. Heart 2007; 93:255-7
  34. Andreotti F, Coluzzi G, Crea F. Letter by Andreotti et al regarding article, "Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) study". Circulation 2007; 115:e313; author reply e314
  35. Bosman DR, Winkler AS, Marsden JT, Macdougall IC, Watkins PJ. Anemia with erythropoietin deficiency occurs early in diabetic nephropathy. Diabetes Care 2001; Djamali A, Becker YT, Simmons WD, Johnson CA, Premasathian N, Becker BN. Increasing hematocrit reduces early posttransplant cardiovascular risk in diabetic transplant recipients. Transplantation 2003; 76:816-20
  36. Rao M, Pereira BJ. Prospective trials on anemia of chronic disease: the Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT). Kidney Int Suppl 2003:S12-9
  37. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39:S1-266
  38. National Kidney Foundation/NKF K/DOQI Guidelines:http://www.kidney.org/professionals/doqi/kdoqi/p5_lab_g4.htm
  39. Nabila AA Abdella, Oluseguna A, Mojiminiyi, Walid A Aldahi. Low erythropoietin precedes the onset of anemia and nephropathy in patients with type 2 diabetes. Abstract 803-P ADA 64th scientific sessions, Orlando FL, June 4-8, 2004

Cite this Article:

  • BibTex
  • RIS
  • APA
  • Harvard
  • IEEE
  • MLA
  • Vancouver
  • Chicago

International Journal of Sciences is Open Access Journal.
This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License.
Author(s) retain the copyrights of this article, though, publication rights are with Alkhaer Publications.

Search Articles

Issue May 2019

Volume 8, May 2019


Table of Contents


Order Print Copy

World-wide Delivery is FREE

Share this Issue with Friends:


Submit your Paper