Hemoglobin predicts long-term survival in dialysis patients: A 15-year single-center longitudinal study and a correlation trend between prealbumin and hemoglobin

Avram, Morrell M.; Blaustein, Daniel A.; Fein, Paul A.; Goel, Naveen Krishan; Chattopadhyay, Jyotiprakas; Mittman, Neal

doi:10.1046/j.1523-1755.64.s87.3.x

Cited by 57 publications

(48 citation statements)

References 27 publications

(23 reference statements)

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“…There are extensive data linking anemia to mortality and HRQOL decrements in hemodialysis (51)(52)(53)(54)(55)(56)(57)(58)(59). We identified 21 studies that includes more than 2000 patients and measured the relationship between hematocrit (Hct) levels and HRQOL (13,22,27,30 -32,35,39,43,45,59 -68).…”

Section: Results Stratified By Traditional Biomarkersmentioning

confidence: 99%

Biomarkers and Health-Related Quality of Life in End-Stage Renal Disease

Spiegel

Melmed

Robbins

et al. 2008

Clinical Journal of the American Society of Nephrology

112

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Background and objectives: Health-related quality of life (HRQOL) predicts mortality in ESRD, yet adoption of HRQOL monitoring is not widespread, and regulatory authorities remain predominantly concerned with monitoring traditional biologic parameters. To assist with future efforts to adopt HRQOL monitoring while acknowledging the importance of biomarkers, this study sought to establish which domains of HRQOL are most affected by ESRD and to measure the strength of evidence linking common biomarkers to HRQOL in ESRD.Design, setting, participants, & measurements: A systematic review was performed to identify studies that measured HRQOL in ESRD. Data were abstracted according to a conceptual model regarding the measurement of HRQOL differences, and HRQOL data were converted to weighted mean effect sizes and correlation coefficients.Results: The impact of ESRD was largest in the Short Form 36 domains of physical functioning (e.g., role-physical, vitality) and smallest in mental functioning (e.g., mental health, role-emotional). Dialysis adequacy, as measured by Kt/V, was a poor correlate for Short Form 36 scores. Similarly, mineral metabolism (e.g., calcium ؋ phosphorous, parathyroid hormone) and inflammatory (e.g., C-reactive protein, TNF) biomarkers had small effect sizes and correlations with HRQOL. In contrast, hematocrit demonstrated small to moderate relationships with mental and physical HRQOL, and nutritional biomarkers (e.g., albumin, creatinine, body mass index) demonstrated moderate to large relationships.Conclusions: HRQOL in ESRD is most affected in the physical domains, and nutritional biomarkers are most closely associated with these domains. In contrast, Kt/V, mineral metabolism indices, and inflammatory markers are poor HRQOL correlates.

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Section: Results Stratified By Traditional Biomarkersmentioning

confidence: 99%

Biomarkers and Health-Related Quality of Life in End-Stage Renal Disease

Spiegel

Melmed

Robbins

et al. 2008

Clinical Journal of the American Society of Nephrology

112

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“…Anemia in CKD is also associated with diminished survival (5)(6)(7)(8)(9)(10). Managing anemia may reduce the need for recurrent blood transfusions and improve patient-reported physical function and exercise tolerance (1,(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Clinical Factors and the Decision to Transfuse Chronic Dialysis Patients

Whitman

Shreay

Gitlin

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Red blood cell transfusion was previously the principle therapy for anemia in CKD but became less prevalent after the introduction of erythropoiesis-stimulating agents. This study used adaptive choice-based conjoint analysis to identify preferences and predictors of transfusion decision-making in CKD.Design, setting, participants, & measurements A computerized adaptive choice-based conjoint survey was administered between June and August of 2012 to nephrologists, internists, and hospitalists listed in the American Medical Association Masterfile. The survey quantified the relative importance of 10 patient attributes, including hemoglobin levels, age, occult blood in stool, severity of illness, eligibility for transplant, iron indices, erythropoiesis-stimulating agents, cardiovascular disease, and functional status. Triggers of transfusions in common dialysis scenarios were studied, and based on adaptive choice-based conjoint-derived preferences, relative importance by performing multivariable regression to identify predictors of transfusion preferences was assessed.Results A total of 350 providers completed the survey (n=305 nephrologists; mean age=46 years; 21% women). Of 10 attributes assessed, absolute hemoglobin level was the most important driver of transfusions, accounting for 29% of decision-making, followed by functional status (16%) and cardiovascular comorbidities (12%); 92% of providers transfused when hemoglobin was 7.5 g/dl, independent of other factors. In multivariable regression, Veterans Administration providers were more likely to transfuse at 8.0 g/dl (odds ratio, 5.9; 95% confidence interval, 1.9 to 18.4). Although transplant eligibility explained only 5% of decision-making, nephrologists were five times more likely to value it as important compared with non-nephrologists (odds ratio, 5.2; 95% confidence interval, 2.4 to11.1).Conclusions Adaptive choice-based conjoint analysis was useful in predicting influences on transfusion decisions. Hemoglobin level, functional status, and cardiovascular comorbidities most strongly influenced transfusion decision-making, but preference variations were observed among subgroups.

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“…The reduction in hemoglobin concentrations is associated with impaired quality of life and may be accompanied by reduced survival (2)(3)(4)(5). On the other hand, large-scale studies found no mortality benefits by targeting higher hematocrit and hemoglobin levels in patients undergoing hemodialysis (6,7).…”

Section: Introductionmentioning

confidence: 99%

The Effect of High-Flux Hemodialysis on Hemoglobin Concentrations in Patients with CKD

Schneider

Drechsler

Krane

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Hemodialysis treatment induces markers of inflammation and oxidative stress, which could affect hemoglobin levels and the response to erythropoietin use. This study sought to determine whether high-flux dialysis would help improve markers of renal anemia, inflammation, and oxidative stress compared with low-flux dialysis.Design, settings, participants, & measurements In a prospective, controlled study, 221 patients undergoing maintenance hemodialysis and receiving darbepoetin-alfa treatment (mean age, 66 years; 55% male) from 19 centers were screened in a 20-week run-in period of low-flux hemodialysis with a synthetic dialysis membrane. Thereafter, 166 patients were enrolled and randomly assigned to receive a synthetic high-flux membrane or to continue on low-flux dialysis for 52 weeks. Data on myeloperoxidase, oxidized LDL, high-sensitivity C-reactive protein, and the Malnutrition Inflammation Score were collected at baseline and after 52 weeks; routine laboratory data, such as hemoglobin, ferritin, and albumin, and the use of darbepoetin-alfa, were also measured in the run-in period.Results After 52 weeks, the low-flux and the high-flux groups did not differ with respect to hemoglobin (mean 6 SD, 11.760.9 g/dl versus 11.761.1 g/dl; P=0.62) or use of darbepoetin-alfa (mean dosage 6 SD, 29.8624.8 mg/wk versus 26.0631.1 mg/wk; P=0.85). Markers of inflammation, oxidative stress, or nutritional status also did not differ between groups.Conclusion Over 1 year, high-flux dialysis had no superior effects on hemoglobin levels or markers of inflammation, oxidative stress, and nutritional status. These data do not support the hypothesis that enhanced convective toxin removal would improve patient outcome.

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Hemoglobin predicts long-term survival in dialysis patients: A 15-year single-center longitudinal study and a correlation trend between prealbumin and hemoglobin

Cited by 57 publications

References 27 publications

Biomarkers and Health-Related Quality of Life in End-Stage Renal Disease

Biomarkers and Health-Related Quality of Life in End-Stage Renal Disease

Clinical Factors and the Decision to Transfuse Chronic Dialysis Patients

The Effect of High-Flux Hemodialysis on Hemoglobin Concentrations in Patients with CKD

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