Abstract: TH-PO0514
European Hemoglobin Target Range Supported in Analysis of Association Between All-Cause Mortality, Stratified by Nutritional and Inflammatory Markers in Patients on Hemodialysis
Session Information
- Dialysis: Novel Therapeutics and Medication Management
November 06, 2025 | 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, SG, Switzerland
- Raimann, Jochen G., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
- Blankenship, Derek, Renal Research Institute, New York, New York, United States
- Kotanko, Peter, Renal Research Institute, New York, New York, United States
- Usvyat, Len A., Renal Research Institute, New York, New York, United States
Background
US hemodialysis (HD) patients treated with erythropoietin stimulating agents (ESAs) for anemia have a hemoglobin (Hgb) target threshold of 10-11 g/dL. Retrospective studies show reduced mortality at higher Hgb levels; 10-12 g/dL range, as in EU is preferable (Mermelstein ASN abstracts). We aim to confirm the association between broader, higher Hgb range and mortality risk after stratifying by nutritional and inflammatory markers in US and EU HD patients.
Methods
Incident HD patients receiving short-acting ESAs for anemia within 90 days of HD initiation were observed. Baseline was defined as 6 months from first ESA dose; deaths were counted for following 18 months. Hgb, neutrophil-to-lymphocyte ratio (NLR), and normalized protein catabolic rate (nPCR) were extracted from EU ApolloDialDb™ and US Fresenius Kidney Care databases. Patients were stratified by median US values. Cox proportional hazards models with penalized splines were fit. Hazard ratio of all cause mortality plotted against mean baseline Hgb for each subset, adjusting for age, sex, diabetes, and cumulative baseline ESA dose.
Results
60,942 HD patients from the US were included (mean age 63.5 ± 14.3 years; 57% male). Mean baseline Hgb 10.4 ± 0.7 g/dL; median NLR 3.8, and nPCR 0.8 g/kg/day. 3,654 incident HD patients from Nephrocare clinics in France, Spain, Slovakia, and Poland (mean baseline Hgb 10.6 ± 0.9 g/dL; median NLR 3, nPCR 0.9 g/kg/day). Hgb ranges associated with decreased mortality by marker strata are shown in table. No significant variation across NLR or nPCR subsets.
Conclusion
Retrospective studies show HD patients on ESAs benefit from higher Hgb targets. In both US and EU HD populations, mortality risk declines across a broader range, even when targeting 11 g/dL. We tested robustness by accounting for nutritional and inflammatory differences that may have biased prior findings. Prospective studies are needed to define optimal target range.
Hgb values where upper CI of MHR fall below 1
| Population | |||
| Marker | Stratification | US | EU |
| NLR | <=3.8 | 10.4 to 12.1 | 10.8 to 12.0 |
| >3.8 | 10.3 to 12.0 | 11 to 12.3 | |
| nPCR | <=0.8 | 10.4 to 12.4 | 10.8 to 12.1 |
| >0.8 | 10.4 to 12.0 | 10.8 to 12.5 | |