ArticleMediterranean journal of hematology and infectious diseases2026
Dynamic Hemoglobin Trajectories in Renal Anemia and Their Association with Frailty Progression and Cardiovascular Events in Non-Dialysis Chronic Kidney Disease.
Article in Mediterranean journal of hematology and infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: In non-dialysis chronic kidney disease (ND-CKD), anemia, frailty, and cardiovascular (CV) complications intersect, yet the prognostic relevance of within-patient hemoglobin (Hb) change over time remains unclear. We tested whether distinct 12-month Hb trajectory patterns are associated with frailty worsening and CV events. Methods: Adults with stage 3-5 ND-CKD and renal anemia (men <13 g/dL; women <12 g/dL) were enrolled at a single center (June-December 2023) and followed monthly for 12 months. Hb was measured monthly. Latent-class mixed models were used to derive stable, declining, and fluctuating Hb trajectories from all available Hb measurements during follow-up. Frailty was assessed at baseline, 6 months, and 12 months. Frailty worsening was prespecified as a ≥1-point increase in the FRAIL score or new onset of weak grip or slow gait. Associations were evaluated using mixed-effects logistic regression (frailty worsening) and cause-specific Cox models (time-to-first composite CV event), adjusting for key clinical covariates. Results: Follow-up at 12 months was available for 182 of 190 (95.8%) participants. Trajectory allocation was 39% stable, 41% declining (mean slope -0.18 g/dL/month), and 20% fluctuating (higher within-person variability). Frailty worsened in 57% of participants who declined, 45% of participants who fluctuated, and 25% of participants who remained stable. Adjusted odds ratios versus Stable were 2.8 (95% CI 1.6-5.0) for Declining and 1.9 (0.9-4.0) for Fluctuating. Over 185 person-years, 46 composite CV events occurred (24.9/100 person-years), and adjusted hazard ratios were 2.6 (1.4-4.9) for Declining and 1.7 (0.8-3.6) for Fluctuating. Conclusion: A declining 12-month hemoglobin trajectory was associated with increased risk of frailty worsening and cardiovascular events compared with a stable profile.
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