Association of Estimated Glomerular Filtration Rate with Hemoglobin Level in Korean Adults: The 2010-2012 Korea National Health and Nutrition Examination Survey

作者：Han Sang Youb; Oh Se Won; Hong Jae Won; Yi Seong Yoon; Noh Jung Hyun; Lee Hye Ran; Kim Dong Jun^*

来源：PLos One, 2016, 11(4): e0150029.

DOI：10.1371/journal.pone.0150029

Purpose
Little is known about anemia in patients with early renal dysfunction. We aimed to investigate the association of hemoglobin level and anemia prevalence with estimated glomerular filtration rate (eGFR) decline using a nation-wide representative sample of the adult Korean population.
Methods
In total, 17,373 participants (7,296 men; weighted n = 18,330,187; mean age, 44.2 +/- 0.3 years; 9,886 women, weighted n = 18,317,454; mean age, 46.9 +/- 0.3 years) were included. eGFR was divided into 5 groups: Group 1,>= 105; Group 2, 90-104; 75-89; Group 4, 60-74; and Group 5, <60 mL/min/1.73m(2).
Results
The weighted anemia prevalence rates were 2.6% in men and 12.8% in women. In men, the weighted hemoglobin level increased with a decrease in eGFR; this value peaked at an eGFR of 60-89 mL/min/1.73m(2) and decreased thereafter at an eGFR of <60 mL/min/1.73m(2) (15.19 +/- 0.03, 15.35 +/- 0.03, 15.53 +/- 0.03, 15.52 +/- 0.06, and 14.90 +/- 0.12 g/dL from Groups 1 to 5) after adjustment for age, college graduation, cancer history, current smoking, waist circumference, serum cholesterol level, serum triglyceride level, and diastolic blood pressure. In women, the weighted hemoglobin level increased with a decrease in eGFR; this value peaked with an eGFR of 75-89 mL/min/1.73m(2) and decreased thereafter (12.90 +/- 0.03, 13.08 +/- 0.02, 13.20 +/- 0.04, 13.14 +/- 0.05, and 12.47 +/- 0.11 g/dL from Groups 1 to 5) after adjustment for menstruation, pregnancy, estrogen replacement, and the above-mentioned variables. In both sexes, the weighted prevalence of anemia with an eGFR of 60-104 mL/min/1.73m(2) was significantly lower than that with an eGFR of >= 105 mL/min/1.73m(2) (men, 3.2 +/- 0.4%, 1.9 +/- 0.3%, 1.8 +/- 0.3%, 2.0 +/- 0.9%, and 18.1 +/- 3.1%; women, 14.0 +/- 0.8%, 11.2 +/- 0.7%, 10.5 +/- 1.0%, 13.2 +/- 1.6%, and 32.3 +/- 3.2% from Groups 1 to 5).
Conclusions
We noted a compensatory increase in the hemoglobin level with a minor decline in kidney in the range of eGFR >= 60 mL/min/1.73m(2)) prior to a marked decrease in hemoglobin level with severe renal dysfunction.