Kidney Week

Abstract: SA-PO793

Evaluation of Gender Differences in the Association between Hemoglobin and Mortality Among Hemodialysed Patients in the JDOPPS

Session Information

• Dialysis: Anemia and Iron Metabolism
  November 04, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

• 605 Dialysis: Anemia and Iron Metabolism

Authors

• Hanafusa, Norio, Tokyo Women's Medical University, Tokyo, Japan

Norio Hanafusa,

• Tu, Charlotte, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Charlotte Tu,

• McCullough, Keith, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Keith McCullough,

• Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Brian Bieber,

• Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Ronald L. Pisoni,

• Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Bruce M. Robinson,

• Hasegawa, Takeshi, Showa University Fujigaoka Hospital, Yokohama, Japan

Takeshi Hasegawa,

• Nangaku, Masaomi, the University of Tokyo School of Medicine, Tokyo, Japan

Masaomi Nangaku,

Background

Lower hemoglobin (Hb) levels can be permissible among female patients without kidney diseases. Little is known about the gender-specific anemia management in hemodialysis (HD) patients.

Methods

We studied the gender differences in the association between baseline or time-varying Hb values in five categories and all-cause mortality on 6,891 patients in phases 3-5 (2005-2015) of Japan Dialysis Outcomes and Practice Patterns Study (JDOPPS). The associations were investigated by Cox proportional hazard models, with different levels of adjustment. The interaction between gender and hemoglobin’s effect on mortality was analyzed using likelihood ratio tests. Several sensitivity analyses were performed, including time-dependent 0-90-day-lagged models and models stratified by vintage and by patient age.

Results

During the median follow-up of 2.58 years, 781 patients died. In the baseline Hb models without lag, a “U-shaped” association (Figure) was observed only in male patients (sex*Hb interaction p=0.23). Similar associations were seen in the lagged time-dependent models. Stratified analyses showed that patients with vintage >1 year or age <75 years exhibited trends similar to the entire population.

Conclusion

The association between Hb and survival might differ between genders in Japanese HD patients. Only male patients showed a “U-shaped” association between Hb and survival, while a moderate linear relationship was observed in females. The detailed investigations in the male patients with higher hemoglobin levels might lead to better understanding of the gender differences in anemia management and of anemia management in whole dialysis population as well.

Adjusted hazard ratio of all-cause mortality, by baseline hemoglobin and gender