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Kidney Week

Abstract: TH-PO257

Hemoglobin (Hgb) Variability and Target Range in Hemodialysis (HD) Patients

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • 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
  • Raimann, Jochen G., Renal Research Institute, New York, New York, United States
Background

Based on randomized controlled trials in CKD patients (pts), in the US, a hgb target range between 10 to 11 g/dL is the mandated. Retrospective studies have shown lower hospitalization and death rates with higher hgb, and a higher risk of death with increased hgb variability. We investigated in this retrospective cohort study of incident HD pts receiving erythropoietin stimulating agent (ESA), the association between all-cause mortality hazard ratio (HR), hgb variability and level.

Methods

We studied a cohort of incident HD pts initiated with a long-acting ESA (Mircera; Vifor) within the first 90 days. In pts with at least twelve hgb values over the 6-months baseline period we quantified mean hgb and variability, as either standard deviation (sd) or slope of a linear model, as metrices. We built proportional hazard models including both mean and variability metrices to predict HR over the following 18 months, adjusted for race, sex, age, diabetes, serum albumin and phosphorus. We then built spline functions to depict HR in a bivariate fashion as a function of baseline mean hgb level and variability.

Results

We studied 64,042 pts out of 517,860 pts in Fresenius Kidney Care clinics. A range between 10.5 and 12.5 g/dL associated with the lowest HR when accounting for variability of hgb during the baseline period (Figure 1 and 2). An increasing slope and increased variability seem to associate with improved survival at low hgb levels.

Conclusion

A wider and upwards shifted hgb target range is associated with favorable mortality outcomes, independent of variability or systematic trends. Hgb variability, possibly a resultant of responsiveness to therapy, confers a survival advantage at lower and higher levels of mean hgb Limitations of retrospective research apply. Adequately powered and designed experimental studies are needed.

Figure 1: HR as a function of baseline hgb mean and slope.
Figure 2: HR as a function of baseline hgb mean and sd.

Funding

  • Commercial Support – Vifor Fresenius Medical Care Pharma Ltd