Patients on dialysis with higher hemoglobin concentrations at short-term reduced risk
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During short exposure and follow-up periods, patients on dialysis with higher hemoglobin concentrations were at a reduced risk for death, hospitalization and ED visits, according to data published in Kidney Medicine.
“Anemia is characterized by a lower-than-normal concentration of hemoglobin in the blood, which compromises delivery of oxygen to body organs and tissues. Most patients with kidney disease requiring dialysis exhibit some degree of anemia. Anemia has been thought to be related to poor outcomes in this patient population,” Eric W. Young, MD, MS, Arbor Research Collaborative for Health in Michigan, and colleagues wrote.
In an observational cohort study, researchers examined data for 371,250 patients on hemodialysis to investigate the correlation between hemoglobin and outcome and utilization measures. Data were derived from the Consolidated Renal Operations in a Web-enabled Network and Medicare claims.
Researchers identified monthly patient hemoglobin concentrations during the 3,326,072 patient-months covered in 2019 and analyzed how these impacted primary outcomes, such as mortality, hospitalization and ED utilization, in the month following the measured concentration. Using Cox regression, researchers calculated adjusted and unadjusted hazard ratios for each monthly observation period.
For 40% of observations, the monthly hemoglobin concentration was less than 10.5 g/dL. Researchers noticed an inverse correlation between mortality and hemoglobin concentration over a range from less than 9 g/dL to 11 g/dL to 11.5 g/dL. While mortality risk increased at hemoglobin levels above 11.5 g/dL, all-cause hospitalization, cause-specific hospitalization and ED utilization were inversely associated with hemoglobin concentration, with risk reduction stabilizing at that level or higher.
“In the absence of erythropoiesis-stimulating agent treatment, most dialysis patients have a hemoglobin concentration below 9 g/dL. The Kidney Disease Improving Global Outcomes anemia guideline asserts that treatment of hemoglobin concentrations below 9 g/dL is associated with improved quality of life and transfusion avoidance. However, uncertainty remains in the hemoglobin range of approximately 9 [g/dL] to 11 g/dL,” Young and colleagues wrote. They added, “Our findings, along with other published studies, suggest that anemia is a sensitive marker of patient risk but not necessarily the cause of poor outcomes.”
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