Clinical and experimental nephrology · 2026
Albuminuria and hematologic profiles across eGFR categories in U.S. adults: NHANES 2001-2018 with detailed iron-biomarker analysis.
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Furuto Yoshitaka
Аннотация
BACKGROUND: Albuminuria and estimated glomerular filtration rate (eGFR) are complementary dimensions of kidney disease, but the hematologic phenotype of albuminuria beyond reduced filtration is incompletely defined.
METHODS: We analyzed adults aged ≥20 years in nine National Health and Nutrition Examination Survey (NHANES) cycles (2001-2018). The primary outcome was hemoglobin; secondary outcomes were anemia, red-cell indices, and serum iron. UACR was modeled per doubling and by KDIGO A1-A3 categories using survey-weighted models adjusted for eGFR and clinical covariates. Ferritin, transferrin saturation (TSAT), iron-binding measures, and soluble transferrin receptor (sTfR) were examined in 2017-2018.
RESULTS: Among 42,634 participants, 40,705 entered the primary model. The prespecified primary hypothesis was not supported: UACR was not significantly associated with mean hemoglobin (beta per doubling, -0.008 g/dL; 95% confidence interval [CI], -0.020 to 0.004). UACR was associated with secondary anemia (odds ratio [OR] per doubling, 1.112; 95% CI, 1.078-1.147; A2 vs A1, OR 1.332; A3 vs A1, OR 1.855). RDW, MCV, MCH, and serum iron differences were small; sTfR showed a small exploratory association. Ferritin- and TSAT-based phenotypes were not significantly associated with UACR.
CONCLUSIONS: The prespecified mean-hemoglobin hypothesis was not supported. Higher UACR was associated with threshold-defined anemia as a secondary outcome, while small red-cell and iron-marker differences did not establish conventional absolute iron deficiency or imply changes in anemia management.
METHODS: We analyzed adults aged ≥20 years in nine National Health and Nutrition Examination Survey (NHANES) cycles (2001-2018). The primary outcome was hemoglobin; secondary outcomes were anemia, red-cell indices, and serum iron. UACR was modeled per doubling and by KDIGO A1-A3 categories using survey-weighted models adjusted for eGFR and clinical covariates. Ferritin, transferrin saturation (TSAT), iron-binding measures, and soluble transferrin receptor (sTfR) were examined in 2017-2018.
RESULTS: Among 42,634 participants, 40,705 entered the primary model. The prespecified primary hypothesis was not supported: UACR was not significantly associated with mean hemoglobin (beta per doubling, -0.008 g/dL; 95% confidence interval [CI], -0.020 to 0.004). UACR was associated with secondary anemia (odds ratio [OR] per doubling, 1.112; 95% CI, 1.078-1.147; A2 vs A1, OR 1.332; A3 vs A1, OR 1.855). RDW, MCV, MCH, and serum iron differences were small; sTfR showed a small exploratory association. Ferritin- and TSAT-based phenotypes were not significantly associated with UACR.
CONCLUSIONS: The prespecified mean-hemoglobin hypothesis was not supported. Higher UACR was associated with threshold-defined anemia as a secondary outcome, while small red-cell and iron-marker differences did not establish conventional absolute iron deficiency or imply changes in anemia management.