In:
PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 9 ( 2021-9-10), p. e0257305-
Kurzfassung:
Anemia is a common complication of chronic kidney disease (CKD). Blood urea nitrogen (BUN) in CKD represents nitrogenous uremic toxin accumulation which could be involved in anemia of CKD. We investigated the effects of BUN independent of estimated glomerular filtration rate (eGFR) on anemia in non-dialysis CKD (NDCKD). Methods This prospective study included 2,196 subjects enrolled in the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD) cohort with BUN and hemoglobin level data. Initially, we investigated the association between BUN and hemoglobin level. To examine the impact of baseline BUN on the incident anemia, a longitudinal study was performed on 1,169 patients without anemia at study enrollment. BUN residuals were obtained from the fitted curve between BUN and eGFR. Anemia was defined as a hemoglobin level of 〈 13.0 g/dL for men and 〈 12.0 g/dL for women. Results BUN residuals were not related to eGFR but to daily protein intake (DPI), while BUN was related to both eGFR and DPI. BUN was inversely associated with hemoglobin level (β -0.03; 95% confidence interval [CI] -0.04, -0.03; P 〈 0.001) in the multivariable linear regression analysis adjusted for multiple confounders including eGFR, and BUN residual used instead of BUN was also inversely associated with hemoglobin level (β -0.03; 95% CI -0.04, -0.02; P 〈 0.001). Among the 1,169 subjects without anemia at baseline, 414 (35.4%) subjects newly developed anemia during the follow-up period of 37.5 ± 22.1 months. In the multivariable Cox regression analysis with adjustment, both high BUN level (Hazard ratio [HR] 1.02; 95% CI 1.01, 1.04; P = 0.002) and BUN residual used instead of BUN (HR 1.02; 95% CI 1.00, 1.04; P = 0.031) increased the risk of anemia development. Moreover, BUN, rather than eGFR, increased the risk of anemia development in patients with CKD stage 3 in the multivariable Cox regression. Conclusion Higher BUN levels derived from inappropriately high protein intake relative to renal function were associated with low hemoglobin levels and the increased risk of anemia independent of eGFR in NDCKD patients.
Materialart:
Online-Ressource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0257305
DOI:
10.1371/journal.pone.0257305.g001
DOI:
10.1371/journal.pone.0257305.g002
DOI:
10.1371/journal.pone.0257305.g003
DOI:
10.1371/journal.pone.0257305.g004
DOI:
10.1371/journal.pone.0257305.t001
DOI:
10.1371/journal.pone.0257305.t002
DOI:
10.1371/journal.pone.0257305.t003
DOI:
10.1371/journal.pone.0257305.t004
DOI:
10.1371/journal.pone.0257305.t005
DOI:
10.1371/journal.pone.0257305.s001
DOI:
10.1371/journal.pone.0257305.s002
DOI:
10.1371/journal.pone.0257305.s003
DOI:
10.1371/journal.pone.0257305.s004
DOI:
10.1371/journal.pone.0257305.s005
DOI:
10.1371/journal.pone.0257305.s006
DOI:
10.1371/journal.pone.0257305.r001
DOI:
10.1371/journal.pone.0257305.r002
DOI:
10.1371/journal.pone.0257305.r003
DOI:
10.1371/journal.pone.0257305.r004
DOI:
10.1371/journal.pone.0257305.r005
DOI:
10.1371/journal.pone.0257305.r006
Sprache:
Englisch
Verlag:
Public Library of Science (PLoS)
Publikationsdatum:
2021
ZDB Id:
2267670-3