Optimal hemoglobin level for anemia treatment in a cohort of hemodialysis patients

Abstract

Background: Anemia is a major risk factor that contributes to mortality in patients with chronic kidney disease. There is controversy over the optimal hemoglobin (1-lb) target in these patients. This study investigated the association between Hb level and mortality in a cohort of hemodialysis (HD) patients in Korea. Methods: This study was a multicenter prospective observational study of maintenance HD patients that was performed for 5 years in western Seoul, Korea. Three hundred and sixty-two participants were enrolled. Laboratory values and mortality were accessed every 6 months. Repeated measures of laboratory values in each interval were averaged to obtain one semiannual mean value. The Hb values were divided into six groups: (1) Hb < 9 g/dL; (2) 9 g/dL <= Hb < 10 g/dL; (3) 10 g/dL <= Hb < 11 g/dL; (4) 11 g/dL <= Hb < 12 g/dL; (5) 12 g/dL <= Hb < 13 g/dL; and (6) Hb >= 13 g/dL. We analyzed the odds ratio for all-cause mortality, based on the Hb group, and adjusted for demographics and various laboratory values. Statistics were performed with SAS, version 9.1 software (SAS Institute Inc., Cary, NC, USA), Results: Mortality odds ratios relative to the reference group (10-11 g/dL) in the fully adjusted model were 3.61 for <9 g/dL; 3.17 for 9-10 g/dL*; 4.65 for 11-12 g/dL*; 5.50 for 12-13 g/dL*; and 2.05 for >= 13 g/dL (* indicates P < 0.05). Conclusion: In this study, a lib level of 10-11 g/dL was associated with the lowest mortality among the groups with lib level < 13 g/dL. Larger interventional trials are warranted to determine the optimal lib target for Korean HD patients. Copyright (C) 2015. The Korean Society of Nephrology. Published by Elsevier.