A recent international study in the Journal of Renal Nutrition found that higher-than-advised blood hemoglobin improved health-related quality of life (HRQOL) in people with stage 3-5 chronic kidney disease who were not on dialysis (ND-CKD). Moreover, there were associations between hemoglobin level and physical activity with disease progression and mortality.*

What They Did

• An international team of medical investigators gathered real-time clinical data from the ongoing CKD Outcomes and Practice Patterns Study (CKDopps).
• Data from 2,121 patients with stage 3-5 ND-CKD at 28 US and 15 Brazilian nephrology clinics was included.
• Average patient age was 68, with nearly 50% being female.
• The patients had various physical activity levels, ethnic backgrounds, and stages of ND-CKD, among other differing factors.
• The researchers first measured blood hemoglobin, then looked at how hemoglobin levels may relate to several indicators of the patients’ medical condition.
• Medical condition indicators included disease progression, mortality, self-reported physical activity, and HRQOL.

What They Found

• Patients with hemoglobin levels higher than 12 g/dL (grams per deciliter) of blood showed the slowest rate of CKD progression, the greatest survival, the highest odds of being physically active, and the best HRQOL compared to patients with lower hemoglobin.
• Patients with severe anemia (low red blood cells and hemoglobin less than 10 g/dL) had the worst HRQOL scores and highest risk of disease progression and early death.
• Importantly, even moderate anemia with hemoglobin levels of 10 to 12 g/dL was associated with poorer HRQOL, faster CKD progression, and higher mortality compared to patients with hemoglobin levels over 12 g/dL.
• Physical inactivity increased mortality risk by 62% and odds of disease progression by 17% compared to those highly active.
• High physical activity was most observed with hemoglobin levels above 10.5 g/dL.

What It Means

Because anemia is a common complication of CKD that increases in frequency with disease progression, an understanding of the relationship between hemoglobin level and clinical outcomes is essential for optimal disease treatment.

• The study suggests that hemoglobin levels higher than the current recommendation of 10.0 to 11.5 g/dL may benefit people with ND-CKD.

Though previous research attempts to link hemoglobin level, CKD progression, HRQOL, and other health indicators have brought conflicting results, the authors concluded this study lays a foundation for future research into the effect of new anemia treatments and physical activity on the well-being and medical outcomes of people with ND-CKD.

Find the research article in the Journal of Renal Nutrition.

Hoshino, J.; Muenz, D.; Zee, J.; et al. (2020, January 21). Associations of Hemoglobin Levels With Health-Related Quality of Life, Physical Activity, and Clinical Outcomes in Persons With Stage 3-5 Nondialysis CKD. Journal of Renal Nutrition. [Epub ahead of print].