A longitudinal analysis of haemoglobin levels and major cardiovascular events

作者：Le Gall L, Alencar de Pinho N, Harambat J, Combe C, Drüeke TB, Choukroun G, Fouque D, Barbieri A, Frimat L, Jacquelinet C, Laville M, Liabeuf S, Pecoits-Filho R, Philipps V, Massy ZA, Stengel B, Prezelin-Reydit M, Leffondré K, CKD-REIN study group · 发表于：Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 年份：2026 · DOI：10.1093/ndt/gfaf221 · 研究领域：Hemoglobins、Cardiovascular Diseases、Renal Insufficiency, Chronic、Anemia、Biomarkers、Humans、Female、Male、Aged、Longitudinal Studies、Middle Aged、Glomerular Filtration Rate

BACKGROUND AND HYPOTHESIS: The standard approach to anaemia in non-dialysis chronic kidney disease (CKD) does not account for potential age- or sex-specific related risks. We assessed differences in the association between haemoglobin and major cardiovascular events (MACE+) in men and women with CKD, by age groups. METHODS: Using 5-year longitudinal data from the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort, we studied patients with CKD stage 2-5 not treated with erythropoiesis-stimulating agents (ESA). The main outcome was MACE+, defined as cardiovascular death, myocardial infarction, stroke or hospitalization for acute heart failure. Competing events were initiation of kidney replacement therapy and non-cardiovascular death. In each of the four predefined subgroups by sex and age (≤70 versus >70 years at baseline), we estimated hazard ratios (HR) of current values of haemoglobin using a cause-specific Cox model adjusted for current values of glomerular filtration rate and transferrin saturation. All current values of biomarkers were first estimated in a multivariate-shared random effect joint model. RESULTS: Analyses considered 29 042 haemoglobin measurements from 2791 patients, and 364 MACE+. The association between current haemoglobin and log hazard of MACE+ was linear in men and J-shaped in women. For a haemoglobin of 10.5 g/dL, as compared with 11.5 g/dL, the hazard of MACE+ at any time was increased by 60% in younger women [HR =...