Fu-Jun Lin1, Xi Zhang2, Lu-Sheng Huang1, Gang Ji1, Hai-Dong Huang1, Yun Xie1, Geng-Ru Jiang1, Xin Zhou3, Wei Lu4. 1. Renal Division, Department of Internal Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China. 2. Clinical Research Unit, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. 3. Clinical Research Unit, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. zhouxin@xinhuamed.com.cn. 4. Renal Division, Department of Internal Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China. luwei03@xinhuamed.com.cn.
Abstract
PURPOSE: Although the association between anemia and cardiovascular mortality in hemodialysis patients is well established, whether hemoglobin variability (Hgb-Var) affects the prognosis remains unclear. We aimed to evaluate the association between Hgb-Var and cardiovascular mortality in Chinese hemodialysis patients. METHODS: This retrospective study included 252 patients starting hemodialysis in Xin Hua Hospital between January 2009 and December 2015. Patients were divided into three tertiles based on Hgb-Var, as reflected by SD Hgbmean, SD Hgbrange, and Hgbdeflection during a 12-month evaluation period after hemodialysis initiation. Left ventricular ejection fraction (EF) and left ventricular mass index (LVMI) were evaluated by echocardiography. Information on cardiovascular deaths occurred by December 2017 was collected. Multivariate Cox regression models were constructed to evaluate the association between Hgb-Var and cardiovascular mortality. RESULTS: A total of 75 deaths and 52 cardiovascular deaths occurred during the 47-month follow-up (range 29.5-70). Under multivariate regression, the subgroup with the highest Hgb-Var had a higher risk of cardiovascular mortality after adjusting for relevant factors (HR vs. lowest SD Hgbmean: 9.15, 95% CI 2.82, 29.693, P < 0.0001; HR vs. lowest SD Hgbrange: 3.81, 95% CI 1.40, 10.38, P = 0.005). Per 1 SD of Hgbmean and Hgbrange elevations were both related to a 10% increase in the cardiovascular mortality risk. Baseline EF% and LVMI did not differ across the Hgb-Var subgroups. EF% upon the last patient visit to the clinic was lower in the subgroup with the highest SD Hgbmean (P = 0.02). CONCLUSIONS: High Hgb-Var is an independent risk factor for cardiovascular mortality in hemodialysis patients and might influence the cardiac function.
PURPOSE: Although the association between anemia and cardiovascular mortality in hemodialysis patients is well established, whether hemoglobin variability (Hgb-Var) affects the prognosis remains unclear. We aimed to evaluate the association between Hgb-Var and cardiovascular mortality in Chinese hemodialysis patients. METHODS: This retrospective study included 252 patients starting hemodialysis in Xin Hua Hospital between January 2009 and December 2015. Patients were divided into three tertiles based on Hgb-Var, as reflected by SD Hgbmean, SD Hgbrange, and Hgbdeflection during a 12-month evaluation period after hemodialysis initiation. Left ventricular ejection fraction (EF) and left ventricular mass index (LVMI) were evaluated by echocardiography. Information on cardiovascular deaths occurred by December 2017 was collected. Multivariate Cox regression models were constructed to evaluate the association between Hgb-Var and cardiovascular mortality. RESULTS: A total of 75 deaths and 52 cardiovascular deaths occurred during the 47-month follow-up (range 29.5-70). Under multivariate regression, the subgroup with the highest Hgb-Var had a higher risk of cardiovascular mortality after adjusting for relevant factors (HR vs. lowest SD Hgbmean: 9.15, 95% CI 2.82, 29.693, P < 0.0001; HR vs. lowest SD Hgbrange: 3.81, 95% CI 1.40, 10.38, P = 0.005). Per 1 SD of Hgbmean and Hgbrange elevations were both related to a 10% increase in the cardiovascular mortality risk. Baseline EF% and LVMI did not differ across the Hgb-Var subgroups. EF% upon the last patient visit to the clinic was lower in the subgroup with the highest SD Hgbmean (P = 0.02). CONCLUSIONS: High Hgb-Var is an independent risk factor for cardiovascular mortality in hemodialysis patients and might influence the cardiac function.
Authors: Peter A McCullough; Christopher T Chan; Eric D Weinhandl; John M Burkart; George L Bakris Journal: Am J Kidney Dis Date: 2016-11 Impact factor: 8.860
Authors: Neil C Boudville; Ognjenka Djurdjev; Iain C Macdougall; Angel L M de Francisco; Gilbert Deray; Anatole Besarab; Paul E Stevens; Rowan G Walker; Pablo Ureña; Pablo Iñigo; Roberto Minutolo; Yosef S Haviv; Karen Yeates; Marisa L Agüera; Jennifer M MacRae; Adeera Levin Journal: Clin J Am Soc Nephrol Date: 2009-05-07 Impact factor: 8.237
Authors: Giuseppe Mancia; Guy De Backer; Anna Dominiczak; Renata Cifkova; Robert Fagard; Giuseppe Germano; Guido Grassi; Anthony M Heagerty; Sverre E Kjeldsen; Stephane Laurent; Krzysztof Narkiewicz; Luis Ruilope; Andrzej Rynkiewicz; Roland E Schmieder; Harry A J Struijker Boudier; Alberto Zanchetti; Alec Vahanian; John Camm; Raffaele De Caterina; Veronica Dean; Kenneth Dickstein; Gerasimos Filippatos; Christian Funck-Brentano; Irene Hellemans; Steen Dalby Kristensen; Keith McGregor; Udo Sechtem; Sigmund Silber; Michal Tendera; Petr Widimsky; Jose Luis Zamorano; Sverre E Kjeldsen; Serap Erdine; Krzysztof Narkiewicz; Wolfgang Kiowski; Enrico Agabiti-Rosei; Ettore Ambrosioni; Renata Cifkova; Anna Dominiczak; Robert Fagard; Anthony M Heagerty; Stephane Laurent; Lars H Lindholm; Giuseppe Mancia; Athanasios Manolis; Peter M Nilsson; Josep Redon; Roland E Schmieder; Harry A J Struijker-Boudier; Margus Viigimaa; Gerasimos Filippatos; Stamatis Adamopoulos; Enrico Agabiti-Rosei; Ettore Ambrosioni; Vicente Bertomeu; Denis Clement; Serap Erdine; Csaba Farsang; Dan Gaita; Wolfgang Kiowski; Gregory Lip; Jean-Michel Mallion; Athanasios J Manolis; Peter M Nilsson; Eoin O'Brien; Piotr Ponikowski; Josep Redon; Frank Ruschitzka; Juan Tamargo; Pieter van Zwieten; Margus Viigimaa; Bernard Waeber; Bryan Williams; Jose Luis Zamorano Journal: Eur Heart J Date: 2007-06-11 Impact factor: 29.983
Authors: Kai-Uwe Eckardt; Armin Scherhag; Iain C Macdougall; Dimitrios Tsakiris; Naomi Clyne; Francesco Locatelli; Michael F Zaug; Hans U Burger; Tilman B Drueke Journal: J Am Soc Nephrol Date: 2009-10-22 Impact factor: 10.121