Takashi Hara1,2, Miho Kimachi1, Tatsuyoshi Ikenoue3, Tadao Akizawa4, Shunichi Fukuhara1,5, Yosuke Yamamoto6. 1. Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan. 2. Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan. 3. Department of Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 4. Division of Nephrology, Showa University School of Medicine, Tokyo, Japan. 5. Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan. 6. Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan, yamamoto.yosuke.5n@kyoto-u.ac.jp.
Abstract
BACKGROUND: Ultrafiltration during hemodialysis (HD) causes hemoconcentration. Little is known about the relationships between intra-dialytic changes in hemoglobin concentration and cardiovascular events. Thus, this study aimed to elucidate the relationships between intra-dialytic changes in hemoglobin concentration and cardiovascular events among HD patients. METHODS: This prospective cohort study was based on the Japanese Dialysis Outcomes and Practice Pattern Study phases 4 and 5. The predictor was the ratio of post-dialysis hemoglobin concentration to pre-dialysis hemoglobin concentration (post-Hb/pre-Hb) at baseline. The primary outcome was major adverse cardiovascular events (MACEs). Hazard ratios (HRs) were estimated using a Cox model for the association between post-Hb/pre-Hb and MACEs, adjusting for potential confounders. RESULTS: A total of 865 patients were enrolled. During a median follow-up of 2.6 years, 145 (16.8%) patients developed MACEs. Patients were divided into 4 categories according to baseline post-Hb/pre-Hb (<1.0, ≥1.0 to <1.1, ≥1.1 to <1.2, and ≥1.2). The multivariable-adjusted HRs for MACEs were 1.69 (95% CI 1.36-2.10), 1.29 (95% CI 1.10-1.51), and 1.31 (95% CI 1.02-1.68) in patients with post-Hb/pre-Hb ratios of <1.0, ≥1.0 to <1.1, and ≥1.2, respectively, compared with the reference post-Hb/pre-Hb ratio of ≥1.1 to <1.2. Cubic spline analyses revealed a U-shaped association between post-Hb/pre-Hb and MACEs. CONCLUSION: High and low intra-dialytic changes in hemoglobin concentration are associated with a high risk of MACEs in patients undergoing HD.
BACKGROUND: Ultrafiltration during hemodialysis (HD) causes hemoconcentration. Little is known about the relationships between intra-dialytic changes in hemoglobin concentration and cardiovascular events. Thus, this study aimed to elucidate the relationships between intra-dialytic changes in hemoglobin concentration and cardiovascular events among HDpatients. METHODS: This prospective cohort study was based on the Japanese Dialysis Outcomes and Practice Pattern Study phases 4 and 5. The predictor was the ratio of post-dialysis hemoglobin concentration to pre-dialysis hemoglobin concentration (post-Hb/pre-Hb) at baseline. The primary outcome was major adverse cardiovascular events (MACEs). Hazard ratios (HRs) were estimated using a Cox model for the association between post-Hb/pre-Hb and MACEs, adjusting for potential confounders. RESULTS: A total of 865 patients were enrolled. During a median follow-up of 2.6 years, 145 (16.8%) patients developed MACEs. Patients were divided into 4 categories according to baseline post-Hb/pre-Hb (<1.0, ≥1.0 to <1.1, ≥1.1 to <1.2, and ≥1.2). The multivariable-adjusted HRs for MACEs were 1.69 (95% CI 1.36-2.10), 1.29 (95% CI 1.10-1.51), and 1.31 (95% CI 1.02-1.68) in patients with post-Hb/pre-Hb ratios of <1.0, ≥1.0 to <1.1, and ≥1.2, respectively, compared with the reference post-Hb/pre-Hb ratio of ≥1.1 to <1.2. Cubic spline analyses revealed a U-shaped association between post-Hb/pre-Hb and MACEs. CONCLUSION: High and low intra-dialytic changes in hemoglobin concentration are associated with a high risk of MACEs in patients undergoing HD.
Authors: Yoshitsugu Obi; Connie M Rhee; Anna T Mathew; Gaurang Shah; Elani Streja; Steven M Brunelli; Csaba P Kovesdy; Rajnish Mehrotra; Kamyar Kalantar-Zadeh Journal: J Am Soc Nephrol Date: 2016-05-11 Impact factor: 10.121
Authors: R Saran; J L Bragg-Gresham; N W Levin; Z J Twardowski; V Wizemann; A Saito; N Kimata; B W Gillespie; C Combe; J Bommer; T Akiba; D L Mapes; E W Young; F K Port Journal: Kidney Int Date: 2006-04 Impact factor: 10.612
Authors: Ronald L Pisoni; Brenda W Gillespie; David M Dickinson; Kenneth Chen; Michael H Kutner; Robert A Wolfe Journal: Am J Kidney Dis Date: 2004-11 Impact factor: 8.860
Authors: Rajiv Saran; Jennifer L Bragg-Gresham; Hugh C Rayner; David A Goodkin; Marcia L Keen; Paul C Van Dijk; Kiyoshi Kurokawa; Luis Piera; Akira Saito; Shunichi Fukuhara; Eric W Young; Philip J Held; Friedrich K Port Journal: Kidney Int Date: 2003-07 Impact factor: 10.612