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Abstract: FR-PO311

The Effects of Serum Hemoglobin on Renal Survival in Pre-Dialysis CKD: Results from the Korean Cohort Study for Outcomes in Patients with CKD (KNOW-CKD)

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Ryu, Ji Young, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Yi, Yongjin, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Kim, Kipyo, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Kim, Sejoong, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Chin, Ho Jun, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Na, Ki Young, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
  • Chae, Dong-Wan, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
Background

The currently recommended hemoglobin (Hb) targets in CKD based on interventional studies using erythropoiesis stimulating agents (ESA) with outcomes such as cardiovascular events might be inappropriate for Hb target aiming for renal survival in CKD. Thus, we analyzed the effect of Hb on renal outcomes in a prospective pre-dialysis CKD cohort.

Methods

We analyzed the data from 2,197 subjects in KNOW-CKD which is a currently on-going prospective cohort study of CKD in Korea (NCT01630486 at www.clinicaltrials.gov). Renal event (RE) was defined by the doubling of serum creatinine or 50% decrease in estimated GFR (eGFR) by CKD-EPI equation from the baseline, or the initiation of renal replacement treatment. The subjects were grouped according to quartile value of Hb, with ranges of Q1 < 11.2 g/dL, Q2 11.3-12.7 g/dL, Q3 12.8-14.2g/dL and Q4 >14.3g/dL respectively.

Results

Out of 2,197 subjects, a total of 577 subjects (26.3%) developed RE during the mean follow up of 1,289.3±659.5 days. Cox regression analysis adjusted by sex, age, eGFR, urine albumin creatinine ratio, systolic blood pressure, medical history of diabetes mellitus(DM), hypertension, coronary artery diseases (CAD), hypercholesterolemia, smoking and alcohol revealed that each 1g/dL increase of Hb was associated with 19.4% risk reduction for RE (HR=0.806; 95% CI 0.758-0.858, p=0.000). Time dependent Cox regression adjusted by the same variables revealed that RE decreased along with Hb quartile groups (Q1: reference, Q2: HR=0.463; 95% CI 0.303-0.709; p=0.000, Q3: HR=0.176; 95% CI 0.094-0.328; p=0.000, Q4: HR=0.099; 95% CI 0.041-0.234; p=0.000, respectively). The favorable effects of Hb on RE were also consistent in subjects with higher cardiovascular risk factors such as DM, CAD, or coronary artery calcium score>100. ESA were used in only 167 subjects (7.6%) in which RE developed in 101 subjects (60.5%). It was also evident in ESA-receiving group in which each 1g/dL increase of Hb was associated with 21.1% risk reduction for RE (HR=0.799; 95% CI 0.677-0.943, p=0.000).

Conclusion

Targeting higher Hb level than current guideline was associated with the favorable renal outcomes in pre-dialysis CKD irrespective of the presence of higher cardiovascular risks or the usage of ESA.