3.1 Effect of anaemia on outcomes
3.1.5 Renal
| Evidence Statements – chronic kidney disease |
 |
 |
 |
 |
 |
|
|---|---|---|---|---|---|---|
| ES1.10 | In patients with CKD (including dialysis patients), anaemia is independently associated with all-cause or cardiovascular mortality. | |||||
| ES1.11 | In adults with CKD, anaemia is independently associated with stroke. | NA | ||||
| ES1.12 | In patients with CKD (including dialysis patients), Hb concentration is associated with reduced quality of life. | |||||
CKD, chronic kidney disease; ES, evidence statement; Hb, haemoglobin
=A; =B; =C; NA,not applicable (see Table 2.1)
One systematic review was identified that did not strictly meet the definition of a Level I study because it included both prospective and retrospective cohort studies.66 The review concluded that studies consistently show an association between reduced Hb and increased mortality. The review also identified 15 prospective cohort studies (Level II), mainly of fair quality, that included patients predialysis and on dialysis.67-81 Eight fair to good-quality prospective cohort studies showed the relationship between different Hb concentrations and mortality.68,69,71,72,74,75,77,79 These studies consistently showed that anaemia is independently associated with all-cause or cardiovascular mortality, with lower Hb concentrations increasing the risk of mortality up to two-fold. There was also evidence from one fair-quality prospective cohort study that anaemia was an independent risk factor for stroke.67
Six fair to poor-quality prospective cohort studies assessed quality of life using the SF-36.70,73,76,78,80,81 These studies concluded that higher Hb concentrations are independently associated with improved quality of life in both predialysis and dialysis patients.