Journal Article

Impact of haemoglobin and erythropoietin dose changes on mortality: a secondary analysis of results from a randomized anaemia management trial

Joanne H. Lau, Azim S. Gangji, Christian G. Rabbat and K. Scott Brimble

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 25, issue 12, pages 4002-4009
Published in print December 2010 | ISSN: 0931-0509
Published online June 2010 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfq330
Impact of haemoglobin and erythropoietin dose changes on mortality: a secondary analysis of results from a randomized anaemia management trial

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Background. Anaemia is a common complication of chronic kidney disease. A number of studies have identified an adverse association between haemoglobin (Hgb) variability and mortality. To date, no study has evaluated the impact of Hgb variability on mortality in the setting of a uniform Hgb target and erythropoiesis-stimulating agents (ESA) dosing strategy.

Methods. One hundred and fifty-four haemodialysis (HD) patients from a previous randomized anaemia management study were followed up for up to 6 years. The impact of Hgb variability and ESA dosing parameters on subsequent mortality risk were evaluated.

Results. More rapid rises in Hgb (Hgb deflectpos) and ESA dose increases were independently associated with mortality in multivariate analysis, whereas more rapid Hgb declines (Hgb deflectneg) and ESA dose decreases were not. Each gram per litre per week increase in Hgb deflectpos was associated with an adjusted hazard ratio (HR) of 1.23 (1.03–1.48), while for every 1000-unit increase in ESA dose, the adjusted HR was 1.12 (1.01–1.24). Factors associated with positive Hgb deflections included frequency and magnitude of ESA dose changes, baseline Hgb, patient weight and presence of an HD catheter.

Conclusions. Rapid Hgb rises and greater average Eprex dose increases were independently associated with a higher mortality risk in HD patients after adjustment for baseline Hgb and Eprex dose. A randomized controlled trial evaluating different ESA dosing strategies in response to individual patient ESA responsiveness is needed.

Keywords: anaemia; erythropoiesis-stimulating agents; haemodialysis; haemoglobin variability; mortality

Journal Article.  4860 words.  Illustrated.

Subjects: Nephrology

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