SEARCHCOHORTnephrology, internal medicine

cohort·nephrology, internal medicine, epidemiology, observational study·PMC10496019

Infectious Risk and Variability of Hemoglobin Level in Patients Undergoing Hemodialysis

Kidney International Reports · 4 authors, 3 centres

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TL;DR

This prospective cohort study found that greater hemoglobin variability in hemodialysis patients was associated with a higher risk of all-cause mortality and a significantly higher risk of infectious events.

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The association for infectious events was more pronounced in patients with lower serum ferritin levels or those receiving iron supplementation.

STUDY TYPE

cohort

SPECIALTY

nephrology

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ORIGINAL PAPER

PMC10496019

Infectious Risk and Variability of Hemoglobin Level in Patients Undergoing Hemodialysis

Kidney International Reports

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ABSTRACT

Abstract Introduction In the management of anemia in chronic kidney disease, hemoglobin levels often fall below or exceed target ranges. Past retrospective cohort studies of patients undergoing hemodialysis with conventional erythropoiesis stimulating agents (ESAs) found that hemoglobin level fluctuations predicted mortality and cardiovascular adverse events; long-acting agents were thereafter widely available. An updated validation by a prospective cohort study was needed. Methods Using Cox regression models, we evaluated associations between hemoglobin variability and all-cause death, hospitalization, and cardiovascular, thrombotic, or infectious adverse event outcomes in 3063 hemodialysis patients’ data from the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS) from 2012 to 2018. Results During a median follow-up time of 2.5 years, all-cause mortality was lowest in the first quartile and tended to be higher in groups with greater hemoglobin variability (hazard ratio [HR]: 95% confidence interval for the fourth quartile of an absolute value of hemoglobin variability: 1.44 [0.99–2.08], P for trend = 0.056). Infectious event incidence in these patients was also lower in the first quartile than for the other quartiles ( P for trend < 0.01). The association was more pronounced in patients with lower serum ferritin levels or iron supplementation. Cardiovascular and thrombotic event incidence was not associated with hemoglobin variability. Conclusions Maintenance hemodialysis patients on ESA treatment with higher hemoglobin variability are at higher risk for all-cause mortality and particularly infectious events. Keywords: anemia, hemodialysis, hemoglobin variability, infection, mortality, prospective observational cohort study

CITATION EXPORT

Hiroshi Nishi, Jui Wang, Yoshihiro Onishi et al.. Infectious Risk and Variability of Hemoglobin Level in Patients Undergoing Hemodialysis. Kidney International Reports. (2023). https://doi.org/10.1016/j.ekir.2023.06.004

AUTHORS

4 · 3 CENTRES

Hiroshi Nishi, Jui Wang, Yoshihiro Onishi, Masaomi Nangaku

1Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
2College of Public Health, National Taiwan University, Taipei, Taiwan
3Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan