Relationship between Hemoglobin Levels Corrected by Interdialytic Weight Gain and Mortality in Japanese Hemodialysis Patients: Miyazaki Dialysis Cohort Study

<div><p>Background</p><p>Although hemoglobin (Hb) levels are affected by a change in the body fluid status, the relationship between Hb levels and mortality while taking interdialytic weight gain (IDWG) at blood sampling into account has not yet been examined in hemodialysis patients.</p><p>Study design</p><p>Cohort study.</p><p>Setting, Participants</p><p>Data from the Miyazaki Dialysis cohort study, including 1375 prevalent hemodialysis patients (median age (interquartile range), 69 (60–77) years, 42.3% female).</p><p>Predictor</p><p>Patients were divided into 5 categories according to baseline Hb levels and two groups based on the median value of IDWG rates at blood sampling at pre-HD on the first dialysis session of the week.</p><p>Outcomes</p><p>All-cause and cardiovascular mortalities during a 3-year follow-up.</p><p>Measurements</p><p>Hazard ratios were estimated using a Cox model for the relationship between Hb categories and mortality, and adjusted for potential confounders such as age, sex, dialysis duration, erythropoiesis-stimulating agent dosage, Kt/V, comorbid conditions, anti-hypertensive drug use, serum albumin, serum C-reactive protein, serum ferritin, and serum intact parathyroid hormone. Patients with Hb levels of 9–9.9 g/dL were set as our reference category.</p><p>Results</p><p>A total of 246 patients (18%) died of all-cause mortality, including 112 cardiovascular deaths. Lower Hb levels (<9.0g/dL) were associated with all-cause mortality (adjusted HRs 2.043 [95% CI, 1.347–3.009]), while Hb levels were not associated with cardiovascular mortality. When patients were divided into two groups using the median value of IDWG rates (high IDWG, ≥5.4% and low IDWG, <5.4%), the correlation between lower Hb levels and all-cause mortality disappeared in high IDWG patients, but was maintained in low IDWG patients (adjusted HRs 3.058 [95% CI,1.575–5.934]). On the other hand, higher Hb levels (≥12g/dL) were associated with cardiovascular mortality in high IDWG patients (adjusted HRs 2.724 [95% CI, 1.010–7.349]), but not in low IDWG patients.</p><p>Conclusion</p><p>In hemodialysis patients, target Hb levels may need to be selected in consideration of IDWG at blood sampling.</p></div

Number of all-cause and cardiovascular deaths and observed Hb levels stratified by the interdialytic weight gain (IDWG) status.

<p>Number of all-cause and cardiovascular deaths and observed Hb levels stratified by the interdialytic weight gain (IDWG) status.</p

Relationship between baseline hemoglobin levels and adjusted hazard ratios of all-cause (5a) and cardiovascular (5b) mortalities by the category of the interdialytic weight gain status.

<p>Relationship between baseline hemoglobin levels and adjusted hazard ratios of all-cause (5a) and cardiovascular (5b) mortalities by the category of the interdialytic weight gain status.</p

Number of all-cause and cardiovascular deaths and observed Hb levels stratified by the interdialytic weight gain (IDWG) status.

<p>Number of all-cause and cardiovascular deaths and observed Hb levels stratified by the interdialytic weight gain (IDWG) status.</p

Baseline patient characteristics stratified by the interdialytic weight gain status.

<p>Baseline patient characteristics stratified by the interdialytic weight gain status.</p

Relationship between baseline hemoglobin levels and hazard ratios of all-cause (2a) and cardiovascular (2b) mortalities.

<p>Relationship between baseline hemoglobin levels and hazard ratios of all-cause (2a) and cardiovascular (2b) mortalities.</p

Baseline patient characteristics.

<p>Baseline patient characteristics.</p

Flow of patients through the study.

<p>Flow of patients through the study.</p

The pleural recurrence free interval in stage I lung cancer patients who underwent computed tomography-guided needle biopsy (CTNB group) versus patients who did not (non-CTNB group) is shown as a Kaplan-Meier estimate.

<p>There was no significant difference between the two groups (p = 0.12, log-rank test).</p

Type of recurrences.

<p>The numbers in parentheses indicate percentages.</p