Kidney Week

Abstract: FR-PO867

Temporal Variations in Hemoglobin before and after Transition to ESRD among Veterans: A Transition of Care in CKD Study

Session Information

• Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular - II
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

• 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

• Ranasinghe, Omesh N, UCLA, Los Angeles, California, United States

Omesh N Ranasinghe,

• Soohoo, Melissa, UC Irvine, Orange, California, United States

Melissa Soohoo,

• Park, Christina, UC Irvine, Orange, California, United States

Christina Park,

• Rhee, Connie, UC Irvine, Orange, California, United States

Connie Rhee,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Kalantar-Zadeh, Kamyar, UC Irvine, Orange, California, United States

Kamyar Kalantar-Zadeh,

• Streja, Elani, UC Irvine, Orange, California, United States

Elani Streja,

Background

Hemoglobin (Hgb) levels decrease as renal function deteriorates and higher Hgb variability is associated with poorer outcomes in patients transitioning to end-stage renal disease (ESRD). However, the relationship of pre- and post-transition Hgb trajectories as well as its association with post-ESRD outcomes is unclear.

Methods

We used a mixed-effects regression model to evaluate the trajectories of Hgb over the 1-year pre- and post-ESRD initiation periods in 31,472 US veterans who transitioned to ESRD in 2007-2014. Trajectories were stratified by baseline 6-month pre-ESRD (prelude) Hgb concentrations. With hierarchically adjusted Cox models, we examined the association of 1-year prelude Hgb slope with early post-ESRD mortality.

Results

The mean±SD age of the cohort was 68±11 years, with a median[IQR] 1-year prelude Hgb slope of -1.6[-2.6, -0.7] g/dL/year. In the prelude period, all Hgb groups showed a gradual decreasing trend and patients with a lower baseline Hgb (<10 g/dL) had the steepest drop before transition. Hgb levels were then corrected towards a normal range with reduced variation across groups in the post-ESRD period. Those with the steepest Hgb decline in the 1-year prelude (≤-3 g/dL/year) had the highest risk of early post-ESRD mortality (HR[95%CI]: 1.16[1.07, 1.26] ref: slope -2< to ≤ -1 g/dL/year) after demographics adjustment, yet the relationship was attenuated after further laboratory and medication adjustments (HR[95%CI]: 1.03[0.95, 1.12]).

Conclusion

Hemoglobin levels rapidly decrease before dialysis initiation and then quickly normalize after initiation and steep pre-ESRD Hgb decline is associated with higher early post-ESRD mortality risk. Further studies are needed to examine the impact of anemia management during the pre- and post-ESRD period on post-transition dialysis outcomes.

Funding

• NIDDK Support