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Abstract: TH-PO954

Hemoglobin Level Variability and Infectious Risk in Hemodialysis Patients in the Era of Long-Acting Injectable Erythropoiesis-Stimulating Agents

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism


  • Nishi, Hiroshi, Tokyo Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Bunkyo-ku, Tokyo, Japan
  • Wang, Jui, iHope International, Kyoto, Japan
  • Onishi, Yoshihiro, iHope International, Kyoto, Japan
  • Nangaku, Masaomi, Tokyo Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Bunkyo-ku, Tokyo, Japan

Target hemoglobin level is suggested in the management of chronic kidney disease. However, hemoglobin levels often fall below or exceed the target range. Past retrospective cohort studies of patients undergoing hemodialysis with conventional short-acting erythropoiesis stimulating agents found that hemoglobin level fluctuations predicted mortality and cardiovascular adverse events; thereafter long-acting agents have been widely available.


We adopted Cox regression models to evaluate associations between hemoglobin level variability and all-cause death, hospitalization, and cardiovascular, thrombotic, or infectious adverse event outcomes in 3,063 hemodialysis patients’ data from the Japanese Dialysis Outcomes and Practice Patterns Study from 2012 to 2018.


All-cause mortality was lowest in the first quartile and tended to be higher in the groups with greater hemoglobin variability (hazard ratio: 95% confidence interval for the fourth quartile of an absolute value of hemoglobin variability: 1.44 [0.99–2.08], p for trend = 0.056). Intriguingly, infectious event incidence was higher than the first quartile for the second through fourth quartiles (p for trend <0.01). The association was more pronounced in patients with lower serum ferritin levels or with iron supplementation. However, cardiovascular and thrombotic event incidence was not associated with hemoglobin variability.


Maintenance hemodialysis patients on erythropoiesis stimulating agent treatment with higher hemoglobin variability are at higher risk for all-cause mortality and particularly infectious events.


  • Commercial Support – Kyowa Kirin