Association of Hemoglobin Levels with Progression to End-stage Kidney Disease in IgA Nephropathy: A Sex-Specific Analysis
In brief
Low hemoglobin linked to fivefold kidney failure risk in women with IgA nephropathy
In this retrospective study of 788 adults with IgA nephropathy, women with hemoglobin below 11 g/dL had about five times the adjusted risk of end-stage kidney disease as women with levels of 12.0 to 12.9 g/dL; no significant link appeared in men. The findings suggest hemoglobin could aid risk assessment, but do not show that raising it prevents kidney failure.
- Journal
- American journal of nephrology (Q1)
- Published
- 10 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Ji-Eun Yoo, Kyu Yeun Kim, Man-Hoon Han, Yong-Jin Kim, Yu Jin Seo, Junyoung Park, et al.
- PMID
- 42858269
- DOI
- 10.1159/ajn/ablag012
Why clinicians should know about it
- Picked for Nephrology (paper of the day, 13 October 2026): Low hemoglobin predicts ESKD in IgA nephropathy
Abstract
Background The prognostic significance of hemoglobin (Hb) levels in immunoglobulin A nephropathy (IgAN) remains uncertain, particularly regarding potential sex-specific differences. We investigated the association between Hb levels and progression to end-stage kidney disease (ESKD) in patients with biopsy-proven IgAN. Methods This multicenter retrospective cohort study included 788 adults with biopsy-proven IgAN diagnosed between 2002 and 2021. Patients were categorized by Hb levels at biopsy (<11.0, 11.0-11.9, 12.0-12.9 [reference], 13.0-13.9, and ≥14.0 g/dL). The primary outcome was progression to ESKD. Multivariable Cox proportional hazards models and sex-stratified analyses were performed. Results During a median follow-up of 70 months, 66 patients (8.4%) progressed to ESKD. In multivariable analysis, Hb <11.0 g/dL was independently associated with a higher risk of ESKD compared with the reference group (adjusted hazard ratio [aHR], 2.88; 95% confidence interval [CI], 1.24-6.68; P=0.014). Restricted cubic spline analysis demonstrated a nonlinear relationship between Hb levels and ESKD risk, with a marked increase below approximately 12 g/dL. In women, low Hb levels remained significantly associated with ESKD (Hb <11.0 g/dL: aHR, 5.10; 95% CI, 1.35-19.29; P=0.016; Hb 11.0-11.9 g/dL: aHR, 4.66; 95% CI, 1.26-17.19; P=0.021), whereas no significant association was observed in men. Lower Hb levels were also associated with more severe tubular atrophy/interstitial fibrosis and endocapillary hypercellularity. Conclusions Low Hb levels at diagnosis were independently associated with progression to ESKD in patients with IgAN, particularly among women. Hb may serve as a simple and clinically useful prognostic marker for risk stratification in IgAN.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.