Abstract: TH-PO965
Hemoglobin (Hgb) Targets in Hemodialysis (HD) Patients: What Is the Optimal Target Range?
Session Information
- Anemia in CKD: Risk Factors, Practice Patterns, Therapies
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Raimann, Jochen G., Renal Research Institute, New York, New York, United States
- Mermelstein, Ariella E., Renal Research Institute, New York, New York, United States
- Kovacevic, Tomislav, Vifor Pharma Management Ltd, Glattbrugg, Zurich, Switzerland
- Hymes, Jeffrey L., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
- Kotanko, Peter, Renal Research Institute, New York, New York, United States
Background
Based on RCTs a hgb target range between 10 to 11 g/dL is mandated in the US. Retrospective analyses have shown lower hospitalization and death rates with higher values. We investigated the association between all-cause mortality hazard ratio (HR) and time spent outside the target range.
Methods
We studied incident HD patients (pts) initiated on a long-acting ESA (Mircera; Vifor) within the first 90 days. In pts with at least 12 hgb during the 6-months baseline (BL), we quantified the patient-individual area under the target excursion curve (AUC) ‘above’ and ‘below’ the target range (10 to 11 g/dL). We used these metrices as predictors in proportional hazard models predicting HR in the following 18 months. We fitted the HR as a spline function of mean BL hgb. We built an additional model, adjusted for race, sex, age, diabetes, serum albumin and phosphorus, as spline functions in a bivariate fashion as a function of AUC above and below as a contour plot. Sensitivity analyses considering cumulative ESA doses, iron status, vintage, excursion frequency, nutrition and inflammation were performed.
Results
We studied 64,042 pts out of 517,860 pts. We found a preferable target range to be between 10.3 and 12.2 g/dL (Figure 1). AUC ‘below’ in the presence of low AUC ‘above’ conferred a higher risk of death, whereas a higher AUC “above” only started to increase risk only at around 150 g/dLxdays (Figure 2). Sensitivity analyses did not change the interpretation.
Conclusion
A wider and higher target range associates with more favorable outcomes. Limitations of retrospective research apply. Adequately powered and designed experimental studies are needed.
Figure 1: HR as a function of mean BL hgb levels.
Figure 2: HR as a function of AUC above and below.
Funding
- Commercial Support – Vifor Fresenius Medical Care Pharma Ltd