Relationship between Hemoglobin Levels Corrected by Interdialytic Weight Gain and Mortality in Japanese Hemodialysis Patients: Miyazaki Dialysis Cohort StudyReport as inadecuate




Relationship between Hemoglobin Levels Corrected by Interdialytic Weight Gain and Mortality in Japanese Hemodialysis Patients: Miyazaki Dialysis Cohort Study - Download this document for free, or read online. Document in PDF available to download.

Background

Although hemoglobin Hb levels are affected by a change in the body fluid status, the relationship between Hb levels and mortality while taking interdialytic weight gain IDWG at blood sampling into account has not yet been examined in hemodialysis patients.

Study design

Cohort study.

Setting, Participants

Data from the Miyazaki Dialysis cohort study, including 1375 prevalent hemodialysis patients median age interquartile range, 69 60–77 years, 42.3% female.

Predictor

Patients were divided into 5 categories according to baseline Hb levels and two groups based on the median value of IDWG rates at blood sampling at pre-HD on the first dialysis session of the week.

Outcomes

All-cause and cardiovascular mortalities during a 3-year follow-up.

Measurements

Hazard ratios were estimated using a Cox model for the relationship between Hb categories and mortality, and adjusted for potential confounders such as age, sex, dialysis duration, erythropoiesis-stimulating agent dosage, Kt-V, comorbid conditions, anti-hypertensive drug use, serum albumin, serum C-reactive protein, serum ferritin, and serum intact parathyroid hormone. Patients with Hb levels of 9–9.9 g-dL were set as our reference category.

Results

A total of 246 patients 18% died of all-cause mortality, including 112 cardiovascular deaths. Lower Hb levels <9.0g-dL were associated with all-cause mortality adjusted HRs 2.043 95% CI, 1.347–3.009, while Hb levels were not associated with cardiovascular mortality. When patients were divided into two groups using the median value of IDWG rates high IDWG, ≥5.4% and low IDWG, <5.4%, the correlation between lower Hb levels and all-cause mortality disappeared in high IDWG patients, but was maintained in low IDWG patients adjusted HRs 3.058 95% CI,1.575–5.934. On the other hand, higher Hb levels ≥12g-dL were associated with cardiovascular mortality in high IDWG patients adjusted HRs 2.724 95% CI, 1.010–7.349, but not in low IDWG patients.

Conclusion

In hemodialysis patients, target Hb levels may need to be selected in consideration of IDWG at blood sampling.



Author: Tatsunori Toida , Takashi Iwakiri , Yuji Sato , Hiroyuki Komatsu , Kazuo Kitamura, Shouichi Fujimoto

Source: http://plos.srce.hr/



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