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Intra-Dialytic Hemoglobin Changes and Cardiovascular Events: A Cohort Study on Dialysis Outcomes and Practice Patterns in Japan.
- Source :
- American Journal of Nephrology; 2019, Vol. 50 Issue 4, p272-280, 9p, 2 Charts, 2 Graphs
- Publication Year :
- 2019
-
Abstract
- <bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>High and low intra-dialytic changes in hemoglobin concentration are associated with a high risk of MACEs in patients undergoing HD. [ABSTRACT FROM AUTHOR]
- Subjects :
- CARDIOVASCULAR diseases
HEMOGLOBINS
COHORT analysis
HEMATOCRIT
ULTRAFILTRATION
Subjects
Details
- Language :
- English
- ISSN :
- 02508095
- Volume :
- 50
- Issue :
- 4
- Database :
- Complementary Index
- Journal :
- American Journal of Nephrology
- Publication Type :
- Academic Journal
- Accession number :
- 139059298
- Full Text :
- https://doi.org/10.1159/000502633