Anemia among Chinese patients with chronic kidney disease and its association with quality of life - results from the Chinese cohort study of chronic kidney disease (C-STRIDE)

Background: Anemia is one of the common complications in patients with chronic kidney disease (CKD). However, there is no systematic investigation on the prevalence of anemia in CKD patients and its relationship with the quality of life in China.

Methods: The data for this study comes from baseline data from the Chinese Chronic Kidney Disease Cohort Study (C-STRIDE), which recruited predialysis CKD patients in China. The kidney disease quality of life summary (KDQOL-TM) was used to assess health-related quality of life (HRQoL). Use linear regression model to estimate the relationship between hemoglobin level and quality of life.

Results: A total of 2921 patients were included in this study. The adjusted prevalence of hemoglobin (Hb) less than 100 g/L was 10.3% (95% confidence interval [CI]: 9.9,11.4%), and showed an increased trend through reduced eGFR levels from 4.0% (95%CI:2.3,5.9%) in the 45-60 ml/min/1.73m² group to 23.4% (95%CI:20.5,26.2%) in the 15-29 ml/min/1.73m² group. The prevalence of anti-anemia treatment was 34.0% (95%CI: 28.7,39.3%) and it is shown by reducing eGFR levels from 15.8% (95%CI:0,36.7%) in the 45-60 ml/min/1.73m² group to 38.2% (95%CI: 30.7,45.2%) in the 15-29 ml/min/1.73m² group. All five dimensions of the KDQOL scores in patients with CKD decreased as hemoglobin declined. After multivariable adjustments,the degrees of decrease became somewhat blunted. For example, compared with hemoglobin of ≥130 g/L, regression coefficients in the hemoglobin of < 100 g/L were - 0.047(95%CI: - 0.049,-0.045) for Symptoms and Problems(S), - 0.047(95%CI: - 0.049,-0.044) for Effects of the Kidney Disease(E), - 0.207(95%CI: - 0.212,-0.203) for Burden of the Kidney Disease(B), - 0.112(95%CI: - 0.115,-0.109) for SF-12 Physical Functioning (PCS), - 0.295(95%CI: - 0.299, -0.292) for SF-12 Mental Functioning (MCS), respectively.

Conclusions: In our cross-sectional analysis of patients with CKD in China, prevalence of both anemia and anti-anemia treatment increased with decreased eGFR. In addition, anemia was associated with reduced HRQoL.