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Relationship between anaemia management at haemodialysis initiation and patient prognosis
Author(s) -
Kataoka Hiroshi,
Tsuchiya Ken,
Naganuma Toshiaki,
Okazaki Masayuki,
Komatsu Mizuki,
Kimura Tomonori,
Shiohira Shunji,
Kawaguchi Hiroshi,
Nitta Kosaku
Publication year - 2015
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12639
Subject(s) - medicine , hazard ratio , proportional hazards model , cohort , kidney disease , retrospective cohort study , incidence (geometry) , myocardial infarction , risk factor , hemodialysis , cardiology , confidence interval , physics , optics
Aim It has been suggested that anaemia management during a transition period to haemodialysis could influence prognosis. In this paper, we have conducted a retrospective investigation on how Hb levels at haemodialysis initiation in patients with chronic kidney disease (CKD) influence the risk of cerebral infarction and cardiovascular events. Methods Seventy‐two patients who underwent initial haemodialysis between May 2012 and April 2014 were designated as subjects of the study and the patients were divided into a cohort with Hb levels ≥8 g/dL and a cohort with <8 g/dL at haemodialysis initiation. The occurrence of cardiovascular events was analyzed using the Kaplan−Meier method and Cox proportional hazards model. Results The cohort with <8 g/dL Hb levels at haemodialysis initiation demonstrated a tendency toward low dosage of ESA or iron preparation in the pre‐haemodialysis (maintenance) phase. Significant incidence of cardiovascular (log rank, P = 0.002) and cerebrovascular (log rank, P = 0.02) events was observed. The results of multivariate analysis of the Cox proportional hazards model indicated that anaemia with <8 g/dL Hb levels at haemodialysis initiation was a significant risk factor for coronary artery (hazard ratio = 12.85, P = 0.003) and cerebrovascular (hazard ratio = 5.11, P = 0.04) diseases post‐haemodialysis. Conclusion The results of this investigation indicate the possible involvement of low Hb levels at haemodialysis initiation as a factor in cardio‐ and cerebrovascular events. There, our results suggested that the administration of adequate dosage of iron preparations and ESA in the pre‐haemodialysis period could help prevent cardio‐ and cerebrovascular events.