Association of Pre-End-Stage Renal Disease Hemoglobin with Early Dialysis Outcomes

Carola Ellen Kleine, Melissa Soohoo, Omesh N. Ranasinghe, Christina Park, Maria V. Marroquin, Yoshitsugu Obi, Connie M. Rhee, Hamid Moradi, Csaba Kovesdy, Kamyar Kalantar-Zadeh, Elani Streja

Research output: Contribution to journalArticle

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Abstract

Background: Incident hemodialysis patients have a high mortality risk within the first months after dialysis initiation. Pre-end-stage renal disease (ESRD) factors like anemia management may impact early post-ESRD outcomes. Therefore, we evaluated the impact of pre-ESRD hemoglobin (Hgb) and pre-ESRD Hgb slope on post-ESRD mortality and hospitalization outcomes. Methods: The study included 31,472 veterans transitioning to ESRD. Using Cox and negative binomial regression models, we evaluated the association of pre-ESRD Hgb and Hgb slope with 12-month post-ESRD all-cause and cardiovascular mortality and hospitalization rates using 4 levels of hierarchical multivariable adjustment, including erythropoietin use and kidney decline in slope models. Results: The cohort was 2% female, 30% African-American, and on average 68 ± 11 years old. Compared to Hgb 10-< 11 g/dL, both low (< 10 g/dL) and high (≥12 g/dL) levels were associated with higher all-cause mortality after full adjustment (HR 1.25 [95% CI 1.15-1.35] and 1.09 [95% CI 1.02-1.18], respectively). Similarly, Hgb exhibited a U-shaped association with CV mortality, while only lower Hgb was associated with a higher hospitalization rate. Neither an annual pre-ESRD decline in Hgb nor increase was associated with higher post-ESRD mortality risk after adjustment for kidney decline. However, we observed a modest J-shaped association between pre-ESRD Hgb slope and post-ESRD hospitalization rate. Conclusions: Lower and higher pre-ESRD Hgb levels are associated with a higher risk of early post-ESRD mortality, while there was no association between the pre-ESRD slope and mortality. An increase in pre-ESRD Hgb slope was associated with higher risk of post-ESRD hospitalization. Additional studies aimed at anemia management prior to ESRD transition are warranted.

Original languageEnglish (US)
Pages (from-to)333-342
Number of pages10
JournalAmerican Journal of Nephrology
Volume47
Issue number5
DOIs
StatePublished - Jun 1 2018

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Chronic Kidney Failure
Dialysis
Hemoglobins
Mortality
Hospitalization
Anemia
Kidney
Risk Adjustment
Statistical Models
Veterans
Erythropoietin
African Americans
Renal Dialysis

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Kleine, C. E., Soohoo, M., Ranasinghe, O. N., Park, C., Marroquin, M. V., Obi, Y., ... Streja, E. (2018). Association of Pre-End-Stage Renal Disease Hemoglobin with Early Dialysis Outcomes. American Journal of Nephrology, 47(5), 333-342. https://doi.org/10.1159/000489223

Association of Pre-End-Stage Renal Disease Hemoglobin with Early Dialysis Outcomes. / Kleine, Carola Ellen; Soohoo, Melissa; Ranasinghe, Omesh N.; Park, Christina; Marroquin, Maria V.; Obi, Yoshitsugu; Rhee, Connie M.; Moradi, Hamid; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar; Streja, Elani.

In: American Journal of Nephrology, Vol. 47, No. 5, 01.06.2018, p. 333-342.

Research output: Contribution to journalArticle

Kleine, CE, Soohoo, M, Ranasinghe, ON, Park, C, Marroquin, MV, Obi, Y, Rhee, CM, Moradi, H, Kovesdy, C, Kalantar-Zadeh, K & Streja, E 2018, 'Association of Pre-End-Stage Renal Disease Hemoglobin with Early Dialysis Outcomes', American Journal of Nephrology, vol. 47, no. 5, pp. 333-342. https://doi.org/10.1159/000489223
Kleine CE, Soohoo M, Ranasinghe ON, Park C, Marroquin MV, Obi Y et al. Association of Pre-End-Stage Renal Disease Hemoglobin with Early Dialysis Outcomes. American Journal of Nephrology. 2018 Jun 1;47(5):333-342. https://doi.org/10.1159/000489223
Kleine, Carola Ellen ; Soohoo, Melissa ; Ranasinghe, Omesh N. ; Park, Christina ; Marroquin, Maria V. ; Obi, Yoshitsugu ; Rhee, Connie M. ; Moradi, Hamid ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar ; Streja, Elani. / Association of Pre-End-Stage Renal Disease Hemoglobin with Early Dialysis Outcomes. In: American Journal of Nephrology. 2018 ; Vol. 47, No. 5. pp. 333-342.
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AU - Marroquin, Maria V.

AU - Obi, Yoshitsugu

AU - Rhee, Connie M.

AU - Moradi, Hamid

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