ASSOCIATION OF HEMOGLOBIN LEVELS WITH PROGRESSION TO END-STAGE KIDNEY DISEASE IN IgA NEPHROPATHY: A SEX-SPECIFIC ANALYSIS

 

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ASSOCIATION OF HEMOGLOBIN LEVELS WITH PROGRESSION TO END-STAGE KIDNEY DISEASE IN IgA NEPHROPATHY: A SEX-SPECIFIC ANALYSIS

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Ji-Eun
Yoo
Ji-Eun Yoo yje5530@hanmail.net Kyungpook National University Hospital Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University Daegu Korea (Republic of) *
Min-Gyu Kim kmg2097@gmail.com Kyungpook National University Hospital Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University Daegu Korea (Republic of) -
You Hyun Jeon yh-jeon@knu.ac.kr Kyungpook National University Hospital Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University Daegu Korea (Republic of) -
Hee-Yeon Jung hy-jung@knu.ac.kr Kyungpook National University Hospital Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University Daegu Korea (Republic of) -
Ji‑Young Choi jyss1002@hanmail.net Kyungpook National University Hospital Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University Daegu Korea (Republic of) -
Jang-Hee Cho jh-cho@knu.ac.kr Kyungpook National University Hospital Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University Daegu Korea (Republic of) -
Chan-Duck Kim drcdkim@knu.ac.kr Kyungpook National University Hospital Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University Daegu Korea (Republic of) -
Yong-Lim Kim ylkim@knu.ac.kr Kyungpook National University Hospital Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University Daegu Korea (Republic of) -
Jeong-Hoon Lim jh-lim@knu.ac.kr Kyungpook National University Hospital Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University Daegu Korea (Republic of) -
Sun-Hee Park sh-park@knu.ac.kr Kyungpook National University Hospital Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University Daegu Korea (Republic of) -
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Anemia is a common complication of chronic kidney disease (CKD) and is associated with faster renal function decline and adverse clinical outcomes. However, its prognostic value in IgA nephropathy (IgAN) and potential sex-specific differences remain unclear. This study aimed to evaluate the association between hemoglobin (Hb) levels and the risk of progression to end-stage kidney disease (ESKD) in patients with IgAN.

This multicenter retrospective cohort study included 788 patients with biopsy-proven IgAN who were diagnosed and treated at two tertiary hospitals between 2002 and 2021. Patients were categorized into five groups based on Hb levels at the time of kidney biopsy (<11, 11–<12, 12–<13 [reference], 13–<14, and ≥14 g/dL). The primary outcome was progression to ESKD. Multivariate Cox proportional hazards models were used to evaluate independent associations, and subgroup analyses were performed according to sex.

During a median follow-up of 70 months, 66 patients (8.4%) progressed to ESKD. Lower Hb levels were significantly associated with increased risk of ESKD after multivariate adjustment (Hb < 11 g/dL; adjusted hazard ratio [aHR], 2.76; 95% confidence interval [CI], 1.19–6.42; P = 0.018). In sex-specific analyses, this association was significant in women (Hb < 11 g/dL; aHR, 5.02; 95% CI, 1.33–18.94; P = 0.017; 11 ≤ Hb < 12 g/dL; aHR, 4.64; 95% CI, 1.26–17.10; P = 0.021), whereas no significant association was observed in men. According to the Oxford classification, higher tubular atrophy/interstitial fibrosis (T) and endocapillary hypercellularity (E) scores were significantly associated with lower hemoglobin levels (P < 0.05).

Low Hb levels at the time of diagnosis were independently associated with an increased risk of progression to ESKD in patients with IgAN. The prognostic effect of anemia was particularly pronounced among women, suggesting a sex-specific vulnerability.

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