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Red blood cell transfusion, hyperkalemia, and heart failure in advanced chronic kidney disease
Author(s) -
Gill Karminder,
Fink Jeffrey C.,
Gilbertson David T.,
Monda Keri L.,
Muntner Paul,
Lafayette Richard A.,
Petersen Jeffrey,
Chertow Glenn M.,
Bradbury Brian D.
Publication year - 2015
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.3779
Subject(s) - medicine , hyperkalemia , heart failure , kidney disease , relative risk , confidence interval , dialysis , blood transfusion , anemia , surgery
Purpose In recent years, the use of red blood cell (RBC) transfusion for the treatment of chronic kidney disease (CKD)‐related anemia has increased. We used the OptumInsight medical claims database to study the association between receiving a transfusion and hyperkalemia and heart failure events. Methods Persons 18–64 years of age with diagnosed stage 4 or 5 CKD (not requiring dialysis) between 2006 and 2010 were followed until their first hospitalization or emergency room visit with a diagnosis of hyperkalemia or heart failure, termination of insurance coverage, or death. We used a case‐only design and conditional logistic regression to estimate rate ratios (RR) and 95% confidence intervals (CIs) describing associations between RBC transfusion and the risks of hyperkalemia or heart failure. We used single (1:1) and variable (1:m) self‐control matching intervals, with adjustment for time‐varying confounders. Results Seven thousand eight hundred twenty‐nine individuals met our inclusion criteria; two‐thirds were age 50 years or older; 43% were women and 51% had diabetes. Rates of hyperkalemia and heart failure were 7.9/100 person‐years (95%CI: 7.3, 8.5) and 16.3/100 person‐years (95%CI: 15.5, 17.2), respectively. RBC transfusion was associated with an increased risk of both hyperkalemia (single interval matched RR = 12.0, 95%CI: 1.3, 109; multiple interval matched RR = 6.1, 95%CI: 2.5, 15.1) and heart failure (single interval matched RR = 1.7, 95%CI: 0.3, 9.2; multiple interval matched RR = 3.8, 95%CI: 1.4, 10.3). Conclusion In patients with advanced CKD, RBC transfusion appears to be associated with an elevated risk of hyperkalemia and heart failure; further investigation into these risks is warranted. Copyright © 2015 John Wiley & Sons, Ltd.