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Association betwixt metabolic parameters and risks of anemia and electrolyte disturbances among stages 3–v chronic kidney disease patients in Taiwan

  • Ya-Lan Yang3,
  • Chien-Yeh Hsuiv,5,
  • Rathi Paramastri1,
  • Hsiu-An Leehalf dozen,7,
  • Po-Yuan Ni1,
  • Mei-Yun Chinthree  na1 &
  • Jane C.-J. Chao1,5,8  na1

BMC Nephrology volume 22, Article number:385 (2021) Cite this article

Abstract

Groundwork

Anemia and electrolyte disturbances are adverse outcomes of chronic kidney disease (CKD). This study explored the association between metabolic parameters with anemia and electrolyte and mineral disorders amid CKD patients in Taiwan.

Methods

This cantankerous-sectional written report with a full of 2176 CKD stages 3–5 patients were collected from the Department of Nephrology at Shuang Ho Hospital, Taipei Medical University through the "Chronic Kidney Disease Common Care Network" database from December 2008 to Apr 2019. A multivariable-adapted logistic regression expressed as odd ratios (OR) was performed to assess the association of metabolic parameters with anemia and electrolyte and mineral disorders.

Results

Elevated diastolic blood force per unit area, fasting claret glucose, and glycated hemoglobin A1c (HbA1c) were associated with presence of anemia. Similarly, elevated fasting blood glucose and HbA1c were associated with hyponatremia (OR = i.59 and 1.58, P for both < 0.01) and hypercalcemia (OR = one.38 and 1.33, P for both < 0.05). There was no significant clan in serum lipid levels with presence of anemia. However, total triglycerides, full cholesterol and low-density lipoprotein-cholesterol were only associated with presence of hypercalcemia (OR = 1.43, i.95 and iii.08, respectively, P for all < 0.05).

Conclusions

Elevated diastolic blood pressure level, fasting claret glucose, HbA1c and blood lipids are associated with anemia or electrolyte and mineral disorders in CKD patients.

Peer Review reports

Background

The U.s. Renal Data System reported in 2016 that Taiwan has the largest incidence and prevalence of end-stage renal disease (ESRD), the advanced stage of chronic kidney affliction (CKD), and has continued to rank first in the world since 2002 [1]. Thus, CKD occupied the top list of medical expenditures of national health insurance, indicating that CKD threatens the wellness of people in Taiwan and becomes a meaning fiscal burden on national medical resource. Anemia is an inevitable and mutual result of patients with CKD, which tin develop in the early on stages of CKD and is commonly observed in more advanced stages in CKD patients [2]. A prospective accomplice study in Taiwan showed that 12.0% of CKD patients in stage 3 were anemic, and the prevalence increased to 58.8 and 92.5% in CKD patients in stages 4 and 5, respectively [3]. Moreover, CKD patients with anemia are more prone to CKD progression, cardiovascular comorbidities, poor quality of life, and higher bloodshed [two, 4, 5].

Additionally, the kidneys play a critical role in regulating body fluid, electrolytes, and acrid-base balance, and CKD can lead to metabolic acidosis, hyperkalemia, hyponatremia, hypercalcemia, and hyperphosphatemia, resulting in serious agin outcomes such as bone mineral disorders, vascular calcification, and fifty-fifty mortality [vi, 7]. Hyperkalemia is increasingly common with the progression of CKD and is one of the life-threatening electrolyte disorders in CKD patients, with a nigh 10-fold risk of death in stages 4 and five [8]. CKD patients with hyperkalemia may develop certain clinical manifestations such equally musculus weakness, cardiac arrhythmias, and cardiac arrest [half dozen]. Meanwhile, hyponatremia is the about common electrolyte aberration in CKD patients, which is probable due to fluid overload and positively correlates with bloodshed and morbidity [ix,10,11]. Similarly, hypercalcemia and hyperphosphatemia are common os mineral disorders in CKD patients and take been associated with vascular calcification, CKD progression, cardiovascular events, and mortality [12,13,14]. Overall, anemia and electrolyte and mineral disorders in CKD patients have major implications for cardiovascular-related comorbidities.

Hypertension, diabetes, and lipid abnormalities are the major causes of CKD [15, 16]. Previous studies take mentioned that high fasting glucose, CKD severity, body mass alphabetize, (BMI), and serum iron are independently associated with anemia amid CKD patients [17, xviii]. Information technology is also well acknowledged that the apply of angiotensin-converting enzyme inhibitors, diuretic treatment, impaired os turnover, and utilize of calcium-based phosphate binders have been associated with electrolyte and mineral disorders in CKD patients [nineteen, 20]. Withal, the existing studies scarcely focused on whether metabolic abnormalities are associated with anemia and electrolyte disturbances in CKD patients. Therefore, our study aimed to investigate the association of metabolic parameters such every bit elevated blood pressure, blood glucose, triglycerides, total cholesterol, low-density lipoprotein (LDL)-cholesterol, and high-density lipoprotein (HDL)-cholesterol with anemia and electrolyte and mineral disorders in CKD patients in Taiwan.

Methods

Research design and patients

In this cross-sectional study, pre-ESRD patients (CKD stages three to 5 with proteinuria) were enrolled in the Department of Nephrology at Shuang Ho Hospital, Taipei Medical University, Taiwan from December 2008 to Apr 2019. The data were retrieved from the "Chronic Kidney Affliction Common Care Network" that has been developed by the doc of the hospital for more than 10 years. We retrieved the patients' data including sociodemographic data, lifestyle, medical records, anthropometry, and blood biochemical data. Before visiting the hospital for CKD treatment and participating in the pre-ESRD nutrition pedagogy plan, all patients signed an informed consent allowing their data to exist used without personal identification for research only. The Taipei Medical University Joint Institutional Review Board approved this study (N202001055).

The data of 4094 patients who had participated in the pre-ESRD plan were retrieved from the platform. Among the 4094 CKD patients, 3885 were stages 3–5 CKD patients, and a full of 1709 patients were excluded due to a history of cardiovascular disease (CVD) (n = 1072), a history of chronic liver illness and cancer (n = 232), tuberculosis and autoimmune disease (n = 48), current erythropoietin treatment (due north = 353) and a lack of estimated glomerular filtration charge per unit (eGFR) measurement (n = four). The reason for excluding patients with presence of CVD and other comorbidities was because the predictor variables were highly associated with CVD, thus presence of CVD may become a confounding factor in our study. Finally, 2176 CKD patients were analyzed in this written report.

Clinical and blood biochemical parameters

Anthropometric information, including body weight and tiptop, were measured using high-accuracy ultrasonic sensors (AHS 700, Kaohsiung, Taiwan). BMI was determined using body weight (kg) divided by height squared (thousandtwo). Systolic and diastolic blood pressure (BP) was determined by oscillometry (OMRON HBP-9020, Taipei, Taiwan). For claret biochemical measurements, all patients were required to fast at to the lowest degree 8 h prior to blood tests. Claret biochemical information including hemoglobin (Hb), fasting blood glucose, albumin, triglycerides, total cholesterol, LDL-cholesterol, HDL-cholesterol, potassium (Yard), sodium (Na), calcium (Ca), and phosphorus (P) were adamant using an auto chemical analyzer (Beckman DxC 800, California, USA). Glycated hemoglobin A1c (HbA1c) was determined by capillary electrophoresis (Sebia Two, Lisses, France).

Anemia was divers as Hb < 130 g/Lfor men and < 120 g/Fifty for women, or current iron supplementation according to the Kidney Affliction Improving Global Outcomes (KDIGO) Anemia Work Group [21]. Serum calcium levels were corrected for serum albumin by using Payne's formula: corrected calcium (C-Ca) (mmol/L = calcium (mmol/L) + 0.02 × [40 – serum albumin (yard/L)]) [22]. Hyperkalemia was defined equally serum potassium > 5.0 mmol/L and hyponatremia was divers as serum sodium < 135 mmol/L [half dozen]. Hypercalcemia was divers equally serum levels of corrected calcium ≥2.37 mmol/Fifty (9.5 mg/dL), while hyperphosphatemia was defined as serum levels of phosphorus ≥one.49 mmol/50 (4.half dozen mg/dL) based on guidelines from National Kidney Foundation [23]. Metabolic parameters were defined as: high systolic BP if ≥130 mmHg with medication, high diastolic BP if ≥85 mmHg with medication [24], high fasting claret glucose if ≥7.0 mmol/L (126 mg/dL) with treatment and loftier HbA1C if ≥6.v% with handling [25]. Moreover, high triglycerides if ≥two.three mmol/L (200 mg/dL) or with treatment, loftier total cholesterol if ≥half dozen.ii mmol/50 (240 mg/dL) or with treatment, high LDL-cholesterol if ≥4.1 mmol/L (160 mg/dL) or with treatment and low HDL-cholesterol if < 1.04 mmol/L (xl mg/dL) or with treatment [26]. The value of eGFR was calculated using the equation of the Modification of Diet in Renal Disease study [27]. Moreover, CKD stages were classified based on eGFR values into: CKD stages 3a (45–59 mL/min/1.73 mtwo), 3b (30–44 mL/min/1.73 one thousandtwo), 4 (15–29 mL/min/i.73 mii) and five (< 15 mL/min/ane.73 mtwo).

Other covariates

We also retrieved sociodemographic and lifestyle data such as age, sex, marital condition, educational level, occupation (unemployment and professional person), cigarette smoking, alcohol consumption, and physical action from the database. Marital status was dichotomized as no (divorced, widowed, and separated) and aye (currently married). Educational level was categorized as depression (high schoolhouse or beneath) and high (to a higher place high schoolhouse). Cigarette smoking and booze use were categorized equally no, one-time (quit smoking or drinking), and current. Data on blazon of physical activeness (e.g., regular walking, fast walking, jogging, dancing, gymnastics, biking or hiking), frequency (5 response options: from never to ≥vii times/week), and duration (5 response options: from never to > 90 min) were collected and retrieved from the database. Concrete activity was defined as no (< 30 min/calendar week) and yes (≥30 min/week). Electric current medication use, including angiotensin 2 receptor blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers, calcium phosphate binders, iron supplements, antihypertensives, hypolipidemic agents, hypoglycemic agents, or insulin injections were besides queried. Patients were categorized as no (never) and yes (≥once) for participation in the nutrition education programme.

Information analysis

Data are presented as numbers and percentages for categorical variables or mean ± standard departure (SD) for continuous variables. For chiselled variables, a chi-square examination was performed to examine differences in characteristics of CKD patients with or without anemia, whereas the full general linear model was used to examine differences in means for continuous variables. The association betwixt metabolic parameters and anemia or electrolyte and mineral disorders was analyzed using a multivariable-adjusted logistic regression model, and the information are reported as odds ratio (OR) and 95% confidence interval (CI). Considering dissimilar Hb cut-off values for anemia in men and women, the association betwixt metabolic parameters and anemia was stratified by sex activity. The regression models were adjusted for age, marital status, educational level, occupation, smoking status, drinking status, physical activity, drug use, nutritional teaching, and BMI in the clan between metabolic parameters and anemia. Too the confounders adjusted in the regression model, sex was too adjusted in the clan betwixt metabolic parameters and electrolyte and mineral disorders. Patients with 'normal' status in all dependent variables were selected as the reference group. A P-value of < 0.05 was considered statistically significant, and STATA software version 13 (STATA Corp LLC, Texas, USA) was used to perform the statistical analysis.

Results

Characteristics of the patients

Table i shows the characteristics of patients with and without anemia. Of 2176 CKD patients, 67% were bloodless, and 56.1% of anemic patients were men. Patients with anemia were more than likely to be older (72.1 ± 14.0 vs. 68.vii ± 13.3 years) and had higher proportions of advanced stages (stages 4 and 5: 35.v and 29.three% vs. twenty.6 and four.half-dozen%), lower educational level (69.9% vs. 60.4%), inactive physical activeness (72.half dozen% vs. 65.iv%) and drug employ (61.2% vs. 56.8%) compared to those without anemia. Moreover, patients with anemia had lower BMI (25.two ± iv.four vs. 26.3 ± 4.two kg/one thousand2), diastolic BP (72 ± 14 vs. 75 ± 13 mmHg), albumin (39.v ± 5.9 vs. 43.1 ± 4.five m/L) and triglycerides (ane.8 ± ane.9 vs. 1.ix ± ane.3 mmol/Fifty) compared to those without anemia. The characteristics of CKD patients stratified by electrolyte and mineral disorders are shown in Additional file ane: Tabular array S1. Among all CKD patients, 18.3% of patients were hyperkalemic, 10.two% of patients were hyponatremic, 12.4% of patients were hypercalcemic and 25.7% of patients were hyperphosphatemic.

Table 1 Characteristics of CKD patients with or without anemiaa

Total size table

Association of metabolic parameters with anemia and electrolyte and mineral disorders

The results of multivariable-adjusted logistic regression showed that CKD patients with increased values of diastolic BP (OR = ane.54, 95% CI 1.09–2.19, P = 0.015), fasting claret glucose (OR = 1.63, 95% CI 1.27–ii.09, P <  0.001) or HbA1c (OR = 1.48, 95% CI i.15–i.89, P = 0.002) were associated with presence of anemia compared to those with normal values (Table 2). However, no significant association was institute between elevated claret lipid parameters and anemia in either sex. The results of multivariable-adjusted logistic regression too showed that CKD patients with high diastolic BP were associated with presence of hyperkalemia (OR = ane.54, 95% CI 1.08–2.21, P = 0.017) compared to those with normal diastolic BP. Patients with elevated fasting blood glucose were associated with presence of hyponatremia (OR = i.59, 95% CI 1.16–2.16, P = 0.004), hypercalcemia (OR = 1.38, 95% CI 1.05–one.83, P = 0.025) or hyperphosphatemia (OR = ane.32, 95% CI ane.06–one.65, P = 0.014). Additionally, CKD patients with elevated HbA1c were significantly associated with presence of hyperkalemia (OR = 1.26, 95% CI 1.00–1.59, P = 0.049), hyponatremia (OR = 1.58, 95% CI one.16–2.16, P = 0.004) or hypercalcemia (OR = 1.33, 95% CI 1.00–1.76, P = 0.049). Meanwhile, CKD patients with loftier levels of triglycerides (OR = 1.43, 95% CI i.03–1.99, P = 0.034), full cholesterol (OR = one.95, 95% CI 1.28–2.96, P = 0.002) and LDL-cholesterol (OR = 3.08, 95% CI i.77–v.34, P <  0.001) were significantly associated with hypercalcemia simply. Moreover, anemic CKD patients had a significant association with presence of hyperkalemia (OR = 3.13, 95% CI 2.32–4.22, P < 0.001), hyponatremia (OR = two.28, 95% CI ane.54–three.38, P < 0.001) and hyperphosphatemia (OR = 3.91, 95% CI ii.93–5.20, P < 0.001) (Tabular array 3).

Tabular array 2 Adjusted odds ratios (OR) and 95% conviction intervals (CI) for anemia, electrolyte and mineral disorders associated with metabolic parametersa

Total size table

Table three Adjusted odds ratios (OR) and 95% conviction intervals (CI) for electrolyte and mineral disorders associated with anemiaa

Full size tabular array

Discussion

In our report, anemic CKD patients were more likely to exist older and male person, and 67% of the subjects in stages 3–v had anemia. Additionally, high fasting blood glucose and HbA1c levels were associated with presence of anemia and electrolyte and mineral imbalance including hyponatremia, hypercalcemia, and hyperphosphatemia. Similar results were also constitute in Japanese CKD patients, in whom the prevalence of anemia in stages 4 and five was 40.one and 60.3%, respectively [28]. Age, gender, and presence of complications could be the factors affecting the development and/or severity of anemia in CKD patients [28, 29]. A previous written report also showed that CKD patients with a diastolic BP between lxxx and 89 mmHg had a lower risk of anemia (OR = 0.38, 95% CI 0.16–0.92) compared to those with a diastolic BP between sixty and 79 mmHg, merely systolic BP was non significantly associated with anemia take chances [xxx]. The prevalence of anemia was higher in uncontrolled hypertensives than in well-controlled hypertensives, suggesting that hypertension is independently associated with increased anemia risk [31]. Moreover, presence of anemia was independently associated with renal events fifty-fifty in overall hypertensive patients with well-controlled blood pressure level [32]. The progression of anemia in CKD patients may be related to the left ventricular hypertrophy that exists in persistent renal failure in combination with decreased Hb levels and increased BP [33].

Similar findings were reported in diabetic patients that the incidence of anemia (33.5% vs. 27.nine%) was increased in diabetic patients with uncontrolled HbA1c levels (> 7.v%) compared to those with controlled HbA1c levels (≤vii.5%) [34]. Chronic hyperglycemia could lead to a cellular hypoxic state in the renal interstitium, which contributes to impaired production of erythropoietin in renal peritubular fibroblasts [35, 36]. Depression erythropoietin levels are a major cause of early anemia in patients with dumb glucose homeostasis [36]. Moreover, anemia per se could be a risk gene for hyperglycemia. Elevated HbA1c levels were associated with decreased serum transferrin saturation, ferritin and mean corpuscular hemoglobin levels in Japanese diabetic women in late pregnancy, and decreased anemia parameters (24–35 weeks of gestation) occurred before elevated HbA1c levels (32–35 weeks of gestation) [37], indicating that anemia might be one of the risk factors for hyperglycemia. Thus, these results advise that anemia could be a risk cistron and effect of hyperglycemia [35,36,37].

Electrolyte and mineral imbalances are common in patients with impaired renal function because the kidney plays an important office in regulating body fluid, electrolytes, acrid-base balance, and iron metabolism [six]. Additionally, anemia in patients with impaired renal function may be associated with disturbance in the metabolism of calcium, phosphate, and hydrogen ions [38]. An increased risk of developing hyperkalemia has also been found in hypertensive patients on antihypertensive therapy [39]. Besides, the present written report showed that CKD patients with high diastolic BP were associated with presence of hyperkalemia. Imbalance of electrolytes potassium, sodium, and calcium were observed more frequently in patients with type 2 diabetes (> 70%) than in patients with hypoglycemia or normal fasting blood glucose, and changes in electrolyte distribution could be due to osmotic fluid shift past hyperglycemia or loss of electrolytes by osmotic diuresis [40]. Our study showed that high HbA1c was significantly associated with presence of hyperkalemia in CKD patients (P = 0.049). Similarly, a study in Benin found that hateful serum potassium levels were significantly higher in diabetic patients compared to non-diabetic controls of the same age and sexual activity [41].

Our results showed that high fasting blood glucose and high HbA1c were associated with presence of hyponatremia in CKD patients. Similarly, a previous report constitute that hyperglycemia in healthy adults with acute insulin deficiency rapidly decreased serum sodium levels, and hyponatremia was reversed by normoglycemia [42]. The plausible mechanism is that hyperglycemia could increment serum osmolality, crusade efflux of water from cells, and lead to further hyponatremia due to dilution [42]. Additionally, our results showed that loftier fasting blood glucose and HbA1c were associated with presence of hypercalcemia and hyperphosphatemia in CKD patients. Consistent with our findings, serum calcium levels were positively associated with fasting blood glucose and insulin resistance, but negatively associated with pancreatic β-prison cell office in salubrious adults [43], suggesting that aberrant regulation of calcium homeostasis may be related to impaired β-prison cell function and elevated glucose levels. According to the results of previous and electric current studies, the relationship between hyperglycemia and hypercalcemia could be cyclic. Hyperphosphatemia frequently occurred in late-stage CKD patients because the excretory capacity of phosphate by the kidney is exhausted [44, 45]. Moreover, hyperphosphatemia has been associated with vascular calcification and abnormal bone mineralization and turnover [46], which was oft and positively associated with CVD morbidity and bloodshed in CKD or diabetic patients [47]. Combined hyperphosphatemia with hyperglycemia promoted vascular calcification in human aortic shine muscle cells compared with hyperphosphatemia or hyperglycemia lonely [47]. Similar to the previous studies [48, 49], we too establish a stiff association between hyperphosphatemia and presence of anemia. High serum phosphorus may lead to increases in the production of uremic toxins as college polyamines and the secretion of parathyroid hormone which has been shown to inhibit erythropoiesis [48].

The present study showed an clan between blood lipids and hypercalcemia in CKD patients. Similarly, previous studies too found a positive association between serum calcium and triglycerides, full cholesterol or HDL-cholesterol [l, 51]. Elevated calcium levels contributed to a decrease in hepatic cholesterol catabolism via a reduction in 7α-hydroxylase, and to an increase in de novo lipid synthesis via an increase in sterol regulatory chemical element-bounden protein-1c, which may serve as a plausible machinery for this clan [50]. All the same, in the present study, no significant relationship was found betwixt lipid profile and anemia. Previous studies besides plant no significant association betwixt Hb levels and serum lipid concentrations [52, 53], and the results have been inconsistent [54]. Therefore, information technology should exist farther investigated whether and how iron condition affects serum lipids in CKD patients.

This study had several limitations. First, this report was a cantankerous-sectional design, making information technology difficult to draw a causal conclusion using our model. A longitudinal written report is needed to clarify the human relationship. Second, we did not collect data on patients' dietary habits in relation to mineral or fe sources. Third, the definition of anemia in the present report lacks other parameters such as serum atomic number 26, ferritin, transferrin saturation, and total iron-binding capacity. For clinical diagnosis of anemia in CKD patients, measurement of hemoglobin along with body iron status is recommended. The strength of our study is that it includes a large sample population of CKD patients, which provides better bear witness for general public interpretation.

Conclusions

In summary, fasting claret glucose and HbA1c are associated with presence of anemia, hyperkalemia, hyponatremia, hypercalcemia, and hyperphosphatemia in patients with phase 3–five CKD. Moreover, the results of the nowadays study propose that there is a discordant association of blood pressure or serum lipid concentrations with anemia or electrolyte and mineral imbalances. A longitudinal study with prospective measurements is needed to farther investigate this clan.

Availability of data and materials

The data that support the findings of this study are bachelor from the Department of Nephrology at Shuang Ho Hospital, Taipei Medical University, but restricted for research use only. The data are not publicly available. Information are available from the authors upon reasonable asking and with permission of Shuang Ho Hospital, Taipei Medical University.

Abbreviations

BMI:

Body mass index

BP:

Blood pressure

Ca:

Calcium

C-Ca:

Corrected calcium

CKD:

Chronic kidney affliction

eGFR:

Estimated glomerular filtration rate

ESRD:

Finish stage renal disease

Hb:

Hemoglobin

HbA1c:

Glycated hemoglobin A1c

HDL:

High-density lipoprotein

K:

Potassium

LDL:

Depression-density lipoprotein

Na:

Sodium

P:

Phosphorus

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Acknowledgements

The authors thank the Department of Nephrology at Shuang Ho Hospital, Taipei Medical University, Taiwan for collecting and providing the database available for this report.

Funding

This enquiry was funded by Shuang Ho Hospital, Taipei Medical University, Taiwan, grant number 110TMU-SHH-31.

Author data

Writer notes

  1. Adi Lukas Kurniawan and Mei-Yun Chin contributed every bit as the starting time author.

Affiliations

  1. School of Nutrition and Wellness Sciences, College of Nutrition, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan

    Adi Lukas Kurniawan, Rathi Paramastri, Po-Yuan Ni & Jane C.-J. Chao

  2. Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences, 365 Ming-De Road, Beitou District, Taipei, 112, Taiwan

    Adi Lukas Kurniawan

  3. Diet and Nutrition Section, Shuang Ho Hospital, Taipei Medical University, 291 Jhongjheng Road, Jhongjheng District, New Taipei, 235, Taiwan

    Ya-Lan Yang & Mei-Yun Chin

  4. Department of Information Management, National Taipei Academy of Nursing and Health Sciences, 365 Ming-De Route, Beitou Commune, Taipei, 112, Taiwan

    Chien-Yeh Hsu

  5. Chief Program in Global Wellness and Development, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan

    Chien-Yeh Hsu & Jane C.-J. Chao

  6. Department of Informatics and Information Engineering, Tamkang University, 151 Yingzhuan Road, Tamsui District, New Taipei, 251, Taiwan

    Hsiu-An Lee

  7. National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 350, Taiwan

    Hsiu-An Lee

  8. Diet Research Center, Taipei Medical Academy Hospital, 252 Wu-Hsing Street, Taipei, 110, Taiwan

    Jane C.-J. Chao

Contributions

A.L.Yard. and J.C.J.C. conceived and designed the study. Y.L.Y., C.Y.H., H.A.L., P.Y.N. and M.Y.C. managed and retrieved the data. A.L.One thousand. analyzed and performed the statistical analysis. C.Y.H. and J.C.J.C. supervised the study. A.L.Thousand., R.P. and J.C.J.C. wrote the manuscript. G.Y.C. and J.C.J.C. provided funding acquisition. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Jane C.-J. Chao.

Ethics declarations

Ethics approving and consent to participate

The report was approved past The Taipei Medical University Joint Institutional Review Board approved this study (N202001055). All patients signed an informed consent allowing their data to be used without personal identification for enquiry simply. All methods for the human written report were conducted in accordance with ethical quidelines and regulations.

Consent for publication

The data in this study did not include any personal information, and all patients were adults. Non applicable.

Competing interests

The authors declare no conflict of involvement.

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Kurniawan, A.50., Yang, YL., Hsu, CY. et al. Association between metabolic parameters and risks of anemia and electrolyte disturbances amongst stages three–5 chronic kidney affliction patients in Taiwan. BMC Nephrol 22, 385 (2021). https://doi.org/x.1186/s12882-021-02590-w

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  • DOI : https://doi.org/10.1186/s12882-021-02590-w

Keywords

  • Anemia
  • Electrolyte disturbances
  • Mineral disorders
  • Chronic kidney affliction
  • Metabolic parameters

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