Association between post-dialysis hemoglobin level and the survival of vascular access

Nishiwaki, Hiroki; Hasegawa, Takeshi; Ikenoue, Tatsuyoshi; Tominaga, Naoto; Yazawa, Masahiko; Kawarazaki, Hiroo; Shibagaki, Yugo; Yamamoto, Yorihiro; Fukuma, Shingo; Yamazaki, Shin; Fukuhara, Shunichi

doi:10.5301/jva.5000798

Cited by 2 publications

(4 citation statements)

References 16 publications

(22 reference statements)

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“…However, the evidence for clinical interpretation of postdialysis hemoglobin levels is limited. Therefore, we conducted a case crossover study to investigate the association between postdialysis hemoglobin levels and vascular access failure among patients undergoing HD in Japanese facilities . We postulated that the excess homoconcentration occurring with dialysis that raises hemoglobin levels might also initiate access thrombosis.…”

Section: Optimal Target Hemoglobin Level In Patients Undergoing Hdmentioning

confidence: 99%

“…Therefore, we conducted a case crossover study to investigate the association between postdialysis hemoglobin levels and vascular access failure among patients undergoing HD in Japanese facilities. 24 We postulated that the excess homoconcentration occurring with dialysis that raises hemoglobin levels might also initiate access thrombosis. We showed that postdialysis hemoglobin levels above 11.8 g/dL had a progressively greater risk for vascular access failure.…”

Section: Level In Patients Un Dergoing Hdmentioning

confidence: 99%

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Anemia in conventional hemodialysis: Finding the optimal treatment balance

Hasegawa

Koiwa

Akizawa

2018

Seminars in Dialysis

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Renal anemia is a serious and common complication in hemodialysis (HD) patients.The introduction of erythropoiesis-stimulating agents (ESAs) has dramatically improved hemoglobin levels and outcomes. Several interventional studies reported that excessive correction of anemia and the massive use of ESA can trigger cardiovascular disease (CVD), and consequently may worsen the prognosis of patients undergoing HD. Therefore, it has been widely recognized that large doses of ESA should be used with caution. An effective use of iron preparations is required to yield the optimal effect of ESA. It is well-known that iron utilization is inhibited under pathological conditions, such as chronic inflammation, resulting in ESA resistance. It is postulated that a new class of therapeutic agents for renal anemia, hypoxia inducible factor prolyl hydroxylase (HIF-PH) inhibitors, will have beneficial treatment effects in patients on HD. HIF is induced by hypoxia and promotes erythropoietin production. In the absence of a hypoxic state, HIF is decomposed by the HIF catabolic enzyme. HIF-PH inhibitors inhibit this degrading enzyme and stimulate endogenous erythropoietin production via HIF induction. Additionally, HIF-PH inhibitors promote effective utilization of iron and raise erythropoietin to physiological concentrations. Accordingly, HIF-PH inhibitors improve anemia and iron metabolism. It appears that this effect persists irrespective of chronic inflammatory conditions. HIF-PH inhibitors do not overshoot erythropoietin above physiological concentrations like ESAs. Therefore, it is hypothesized that HIF-PH inhibitors would not increase the risk of CVD in patients undergoing HD.

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Section: Optimal Target Hemoglobin Level In Patients Undergoing Hdmentioning

confidence: 99%

Section: Level In Patients Un Dergoing Hdmentioning

confidence: 99%

Anemia in conventional hemodialysis: Finding the optimal treatment balance

Hasegawa

Koiwa

Akizawa

2018

Seminars in Dialysis

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“…The hemoglobin (Hb) level before hemodialysis (HD) is generally used as an indicator to treat renal anemia in patients undergoing HD and is also included in most clinical research studies and guidelines [1,2]. However, several studies have described post-HD Hb levels and hematocrit values (S1 Table) [3–10], and a recent study has found that Hb levels 4, 24, and 48 hours after an HD session remain as high as pre-Hb levels and do not differ significantly from immediate post-HD Hb levels [6]. By measuring post-HD Hb levels, we can obtain information about the difference in Hb levels between before and after HD (hereinafter called “ΔHb”).…”

Section: Introductionmentioning

confidence: 99%

“…By measuring post-HD Hb levels, we can obtain information about the difference in Hb levels between before and after HD (hereinafter called “ΔHb”). However, to our knowledge, only a single study [10] has examined ΔHb in detail. In addition, few clinical research studies have directly examined the association between post-HD Hb levels and patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

The association of the difference in hemoglobin levels before and after hemodialysis with the risk of 1-year mortality in patients undergoing hemodialysis. Results from a nationwide cohort study of the Japanese Renal Data Registry

et al. 2019

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BackgroundFew clinical studies have directly examined the associations of hemoglobin (Hb) levels after hemodialysis (HD) and of the difference in Hb levels before and after HD (ΔHb) with patient outcomes. The present study aimed to determine ΔHb and post-HD Hb levels with nationwide data and to examine their associations with all-cause mortality in patients undergoing HD.MethodsThis study is based on data from 2008 and 2009 recorded in the Japanese Renal Data Registry. Study endpoints were all-cause mortality within 1-year. The ΔHb and post-HD Hb level as categorical variables using Cox regression for 1-year mortality, adjusting for potential confounders.ResultsThe median ΔHb was 1.0 g/dl, and the post-HD Hb level was 11.3 g/d. The median pre-HD Hb level was 10.4 g/dl. The risk of mortality was lower with a ΔHb of 0 to 1.0 g/dl (adjusted hazard ratio [aHR], 0.90; 95% confidence interval [CI], 0.70–1.01) or > 1.0 g/dl (aHR, 0.73; 95% CI, 0.64–0.84) than with a ΔHb < 0 g/dl. The risk for mortality was also lower with a post-HD Hb of 10 to 11 g/dl (aHR, 0.82; 95% CI, 0.73–0.92), 11 to 12 g/dl (aHR, 0.77; 95% CI, 0.68–0.87), or > 12 g/dl (aHR, 0.77; 95% CI, 0.68–0.87) than with a post-HD Hb < 10 g/dl.ConclusionsBoth a low ΔHb and a low post-HD Hb level were associated with a higher risk of 1-year mortality.

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Association between post-dialysis hemoglobin level and the survival of vascular access

Abstract: A higher post-dialysis hemoglobin level was associated with vascular access failure. Higher post-dialysis Hb could be a factor that triggers vascular access failure.

Cited by 2 publications

References 16 publications

Anemia in conventional hemodialysis: Finding the optimal treatment balance

Anemia in conventional hemodialysis: Finding the optimal treatment balance

The association of the difference in hemoglobin levels before and after hemodialysis with the risk of 1-year mortality in patients undergoing hemodialysis. Results from a nationwide cohort study of the Japanese Renal Data Registry

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