Yukio Maruyama1,2, Eiichiro Kanda3,4, Kan Kikuchi3,5, Masanori Abe3,6, Ikuto Masakane3,7, Takashi Yokoo8, Kosaku Nitta3,9. 1. Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-ku, Tokyo, 1058461, Japan. maruyama@td5.so-net.ne.jp. 2. Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan. maruyama@td5.so-net.ne.jp. 3. Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan. 4. Medical Science, Kawasaki Medical School, Okayama, Japan. 5. Shimoochiai Clinic, Tokyo, Japan. 6. Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan. 7. Department Nephrology, Honcho Yabuki Clinic, Yamagata, Japan. 8. Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-ku, Tokyo, 1058461, Japan. 9. Fourth Department of Internal Medicine, Tokyo Women's Medical University, Tokyo, Japan.
Abstract
BACKGROUND: The prevalence and severity of anemia differ between diabetic and non-diabetic patients. We investigated whether the effect of hemoglobin (Hb) on patient outcome was affected by the presence or absence of diabetes among Japanese patients receiving chronic hemodialysis (HD). METHODS: We enrolled 149,308 patients from a nationwide dialysis registry in Japan at the end of 2012 (mean age, 67.6 ± 12.3 years; male, 61.7%; diabetes, 43.5%; median dialysis duration, 65 months) who underwent three HD sessions weekly. One-year all-cause and cardiovascular (CV) mortality were assessed using Cox regression analysis and competing-risks regression analysis. We used multiple imputation to deal with missing covariate data. RESULTS: Baseline Hb and serum ferritin levels were independently associated with all-cause and CV mortality. In non-diabetic patients, a significantly higher risk for all-cause mortality compared to the reference group (10 to 11 g/dL) was observed in patients with Hb < 8 g/dL (hazard ratio (HR): 1.266; 95% confidence interval (CI) 1.097-1.460) and 8 to 9 g/dL(HR: 1.153; 95% CI 1.030-1.290). On the other hand, diabetic HD patients in the same Hb category group did not have increased risk of all-cause mortality. CONCLUSIONS: We found that non-diabetic HD patients had an increased risk of all-cause mortality if they had lower Hb levels, whereas the effect of Hb levels on mortality was attenuated in diabetic HD patients. These data suggest that the association between Hb levels and mortality rate could be different between diabetic and non-diabetic HD patients.
BACKGROUND: The prevalence and severity of anemia differ between diabetic and non-diabeticpatients. We investigated whether the effect of hemoglobin (Hb) on patient outcome was affected by the presence or absence of diabetes among Japanese patients receiving chronic hemodialysis (HD). METHODS: We enrolled 149,308 patients from a nationwide dialysis registry in Japan at the end of 2012 (mean age, 67.6 ± 12.3 years; male, 61.7%; diabetes, 43.5%; median dialysis duration, 65 months) who underwent three HD sessions weekly. One-year all-cause and cardiovascular (CV) mortality were assessed using Cox regression analysis and competing-risks regression analysis. We used multiple imputation to deal with missing covariate data. RESULTS: Baseline Hb and serum ferritin levels were independently associated with all-cause and CV mortality. In non-diabeticpatients, a significantly higher risk for all-cause mortality compared to the reference group (10 to 11 g/dL) was observed in patients with Hb < 8 g/dL (hazard ratio (HR): 1.266; 95% confidence interval (CI) 1.097-1.460) and 8 to 9 g/dL(HR: 1.153; 95% CI 1.030-1.290). On the other hand, diabeticHDpatients in the same Hb category group did not have increased risk of all-cause mortality. CONCLUSIONS: We found that non-diabeticHDpatients had an increased risk of all-cause mortality if they had lower Hb levels, whereas the effect of Hb levels on mortality was attenuated in diabeticHDpatients. These data suggest that the association between Hb levels and mortality rate could be different between diabetic and non-diabeticHDpatients.
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