Abstract: FR-PO398
Hemoglobin (hgb) Target Range Associated with All-Cause Repeated Hospitalization in Patients on Hemodialysis Treated with Mircera
Session Information
- Hemodialysis Epidemiology and Outcomes
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Mermelstein, Ariella E., Renal Research Institute, New York, New York, United States
- Kovacevic, Tomislav, Vifor Fresenius Medical Care Renal Pharma Ltd, St Gallen, St Gallen, Switzerland
- Hymes, Jeffrey L., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
- Wang, Yuedong, University of California Santa Barbara, Santa Barbara, California, United States
- Raimann, Jochen G., Renal Research Institute, New York, New York, United States
- Kotanko, Peter, Renal Research Institute, New York, New York, United States
Background
A hgb of 10 to 11 g/dL is recommended for anemia HD patients treated with erythropoietin stimulating agents (ESAs) in the US. However, some recent retrospective analyses have shown lower hospitalization and death rates with higher hgb values than target. We previously studied the mortality risk and found the better range of hgb to be between 10.2 and 12.4 g/dL (Raimann, ASN 2023). We repeated our analyses to determine the risk of repeated hospitalizations for all causes.
Methods
Incident HD patients starting Mircera within 90 days of HD initiation were included. In patients with at least 5 hgb measurements during the 6 month baseline period after first dose of ESA, we quantified the mean hgb. We created a proportional hazard model for repeated hospitalizations in the following 18 months. The hazard ratio was plotted as a univariate spline function versus mean baseline hgb. Model was adjusted for age, sex, race, diabetes, serum albumin, and phosphate.
Results
We studied 62,181 HD patients (63.4 years, 57.2% male, 38.8% diabetic). The mean baseline hgb was 10.42 ± 0.72 g/dL). The hgb range associated with a significantly lower hazard ratio for all-cause hospitalization was 10.1 to 12.2 g/dL.
Conclusion
Current US guidelines call for a hgb target range of 10 to 11 g/dL. In our observational research, we identified a wider and higher hgb range to be associated with lower all-cause hospitalization. Limitations of retrospective research apply. Adequately powered and designed experimental studies are needed.
Hazard ratio of all-cause repeated hospitalizations and mean baseline hemoglobin quantified with a Cox Proportional Hazards model for repeated events. Adjusted for age, sex, race, diabetes, albumin, and phosphate.
Funding
- Commercial Support – Vifor Fresenius Medical Care Pharma Ltd