Yasin ŞAHİNTÜRK, Metin SARIKAYA, Aygül ÖZDEMİR, Ali Rıza ÇALIŞKAN

Do hemoglobin levels affect the progression of chronic kidney disease in patients with stage 3-4 chronic kidney disease?

Aim: We aimed in our study to evaluate the effect of anemia on renal progression in patients with stage 3-4 CKD.Material and Methods: A total of 88 patients, 44 females, and 44 males, were followed up in a pre-dialysis outpatient clinic with adiagnosis of stage 3-4 CKD. Forty-four of these patients had hemoglobin (HGB) value above 12 g/dL, whereas 44 of them had avalue between 10-12 g/dL. We accepted the first group as normal and the second group as mild anemia. We followed up the mildanemia group without Erythropoietin (EPO) treatment. Glomerular filtration rate (GFR) values were calculated with BUN, creatinine,hemoglobin, albumin and uric acid levels that had been measured in four months periods. GFR values were calculated using theMDRD formula. The follow-up duration of the two groups was twelve months.Results: Initial, fourth, eighth and twelfth months GFR values of the patients were calculated. There was no significant difference(F=1.242, p>0.05) between the GFR values of first, fourth, eighth, and twelfth months controls. GFR values measured at four differenttimes were similar. Also, the GFR values showed no difference between the HGB groups (F=1.892, p>0.05). HGB levels did not affectGFR values measured at different times.Conclusion: It is thought that in stage 3-4 CKD, maintenance of-HGB level at 10-12 g/dL or above 12 g/dL had a similar effect onrenal progression. During the follow-up of CKD, HGB level above 10 g/dL is sufficient for controlling the progression of CKD.

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1. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39:S1-266.
2. Yu HT. Progression of chronic renal failure. Arc Intern Med 2003;163: 1417-29.
3. Hebert A, T Greene, A Levey, et al. High urine volume and low urine osmolality are risk factors for faster progression of renal disease. Am J Kidney Dis 2003;41:962-71.
4. Süleymanlar G, Serdengeçti K, Altiparmak MR, et al. Trends in renal replacement therapy in Turkey, 1996-2008. Am J Kidney Dis 2011;57:456-65.
5. 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.
6. Astor BC, Muntner P, Levin A, et al. Association of kidney function with anemia. Arc Intern Med 2002;162:1401-8.
7. Stevens PE, Levin A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013;158: 825-30.
8. Eschbach JW, Haley NR, Egrie JC, et al. A comparison of the responses to recombinant human erythropoietin in normal and uremic subjects. Kidney Int 1992;42:407-16.
9. Kliger AS, Foley RN, Goldfarb DS, et al. KDOQI US Commentary on the 2012 KDIGO clinical practice guideline for anemia in CKD. Am J Kidney Dis 2013;62:849-59.
10. Ma JZ, Ebben J, Xia H, et al. Hematocrit level and associated mortality in hemodialysis patients. J Am Soc Nephrol 1999;10:610-9.
11. Fernández-Rodríguez AM, Guindeo-Casasús MC, Molero- Labarta T, et al. Diagnosis of iron deficiency in chronic renal failure. Am J Kidney Dis 1999;34:508-13.
12. Mohanram A, Zhang Z, Shahinfar S, et al. Anemia and endstage renal disease in patients with type 2 diabetes and nephropathy. Kidney Int 2004;66:1131-8.
13. Chatterjee PK. Pleiotropic renal actions of erythropoietin. Lancet 2005;365:1890-2.
14. Gouva C, Nikolopoulos P, Ioannidis JP, et al. Treating anemia early in renal failure patients slows the decline of renal function: a randomized controlled trial. Kidney Int 2004;66:753-60.
15. Roth D, Smith RD, Schulman G, et al. Effects of recombinant human erythropoietin on renal function in chronic renal failure predialysis patients. Am J Kidney Dis 1994;24:777-84.
16. Kuriyama S, Tomonari H, Yoshida H, et al. Reversal of anemia by erythropoietin therapy retards the progression of chronic renal failure, especially in nondiabetic patients. Nephron 1997;77:176-85.
17. Singh AK, Szczech L, Tang KL, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 2006;355:2085-98.
18. Pfeffer MA, Burdmann EA, Chen CY, et al. A Trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med 2009;361:2019-32.
19. Drüeke TB, Locatelli F, Clyne N, et al. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 2006;355:2071-84.