Hemoglobin associated with dialysis outcomes in pre-end stage renal disease

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Hemoglobin associated with dialysis outcomes in pre-end stage renal disease

It is a fact that incident hemodialysis patients have a high mortality risk within the first months after dialysis initiation.

There is a presumption that pre-end stage renal disease (ESRD) factors like anemia management could have an influence on early post-ESRD outcomes. Nephrologists at the University of California Irvine (US) evaluated the impact of pre-ESRD hemoglobin (Hgb) and pre-ESRD Hgb slope on post-ESRD mortality and hospitalization outcomes (Kleine CE et al, Association of Pre-End-Stage Renal Disease Hemoglobin with Early Dialysis Outcomes. Am J Nephrol 2018;47:333-342). They found that lower and higher pre-ESRD Hgb levels are associated with a higher risk of early post-ESRD mortality.

31,472 patients (2% female, 30% African-American, average 68 years old) transitioning to ESRD were included in the analysis. Cox and negative binomial regression models showed that both low (< 10 g/dL) and high (≥12 g/dL) Hgb levels were associated with higher all-cause mortality after full adjustment, compared to Hgb 10–< 11 g/dL (HR 1.25 [95% CI 1.15–1.35] and 1.09 [95% CI 1.02–1.18], respectively). Similarly, the authors found a U-shaped association between Hgb and CV mortality, while only lower Hgb was associated with a higher hospitalization rate. Neither an annual pre-ESRD decline in Hgb nor increase was associated with higher post-ESRD mortality risk after adjustment for kidney decline. However, the authors also observed a (modest) J-shaped association between pre-ESRD Hgb slope and post-ESRD hospitalization rate.

1. Both lower and higher pre-ESRD Hgb levels are associated with a higher risk of early post-ESRD mortality.

2. There is no association between the pre-ESRD slope and mortality.

3. An increase in pre-ESRD Hgb slope was associated with higher risk of post-ESRD hospitalization.

The authors now call for more studies targeting anemia management prior to ESRD transition.

Link to the study: https://www.karger.com/Article/Abstract/489223