Associations between changes in hemoglobin and administered erythropoiesis-stimulating agent and survival in hemodialysis patients

Deborah L. Regidor, Joel D. Kopple, Csaba Kovesdy, Ryan D. Kilpatrick, Charles J. McAllister, Jason Aronovitz, Sander Greenland, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

317 Citations (Scopus)

Abstract

Although treating anemia of chronic kidney disease by erythropoiesis- stimulating agents (ESA) may improve survival, most studies have examined associations between baseline hemoglobin values and survival and ignored variations in clinical and laboratory measures over time. It is not clear whether longitudinal changes in hemoglobin or administered ESA have meaningful associations with survival after adjustment for time-varying confounders. With the use of time-dependent Cox regression models, longitudinal associations were examined between survival and quarterly (13-wk averaged) hemoglobin values and administered ESA dose in a 2-yr (July 2001 to June 2003) cohort of 58,058 maintenance hemodialysis patients from a large dialysis organization (DaVita) in the United States. After time-dependent and multivariate adjustment for case mix, quarterly varying administered intravenous iron and ESA doses, iron markers, and nutritional status, hemoglobin levels between 12 and 13 g/dl were associated with the greatest survival. Among prevalent patients, the lower range of the recommended Kidney Disease Quality Outcomes Initiative hemoglobin target (11 to 11.5 g/dl) was associated with a higher death risk compared with the 11.5- to 12-g/dl range. A decrease or increase in hemoglobin over time was associated with higher or lower death risk, respectively, independent of baseline hemoglobin. Administration of any dose of ESA was associated with better survival, whereas among those who received ESA, requiring higher doses were surrogates of higher death risk. In this observational study, greater survival was associated with a baseline hemoglobin between 12 and 13 g/dl, treatment with ESA, and rising hemoglobin. Falling hemoglobin and requiring higher ESA doses were associated with decreased survival. Randomized clinical trials are required to examine these associations.

Original languageEnglish (US)
Pages (from-to)1181-1191
Number of pages11
JournalJournal of the American Society of Nephrology
Volume17
Issue number4
DOIs
StatePublished - Apr 1 2006
Externally publishedYes

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Hematinics
Renal Dialysis
Hemoglobins
Survival
Iron
Risk Adjustment
Kidney Diseases
Nutritional Status
Chronic Renal Insufficiency
Proportional Hazards Models
Observational Studies
Anemia
Dialysis
Randomized Controlled Trials
Maintenance
Organizations

All Science Journal Classification (ASJC) codes

  • Nephrology

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Associations between changes in hemoglobin and administered erythropoiesis-stimulating agent and survival in hemodialysis patients. / Regidor, Deborah L.; Kopple, Joel D.; Kovesdy, Csaba; Kilpatrick, Ryan D.; McAllister, Charles J.; Aronovitz, Jason; Greenland, Sander; Kalantar-Zadeh, Kamyar.

In: Journal of the American Society of Nephrology, Vol. 17, No. 4, 01.04.2006, p. 1181-1191.

Research output: Contribution to journalArticle

Regidor, Deborah L. ; Kopple, Joel D. ; Kovesdy, Csaba ; Kilpatrick, Ryan D. ; McAllister, Charles J. ; Aronovitz, Jason ; Greenland, Sander ; Kalantar-Zadeh, Kamyar. / Associations between changes in hemoglobin and administered erythropoiesis-stimulating agent and survival in hemodialysis patients. In: Journal of the American Society of Nephrology. 2006 ; Vol. 17, No. 4. pp. 1181-1191.
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