Relationship between anaemia management at haemodialysis initiation and patient prognosis

Kataoka, Hiroshi; Tsuchiya, Ken; Naganuma, Toshiaki; Okazaki, Masayuki; Komatsu, Masatoshi; Kimura, Tomonori; Shiohira, Shunji; Kawaguchi, Hiroshi; Nitta, Kosaku

doi:10.1111/nep.12639

Cited by 13 publications

(12 citation statements)

References 26 publications

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“…Kataoka reported that this depression was observed even after use of long-acting ESA in 72 incident dialysis patients [6]. The difference in this study was thought to be due to both number of patients and initiation timing.…”

Section: Discussioncontrasting

confidence: 45%

Lower Hb at the initiation of dialysis does not adversely affect 1-year mortality rate

et al. 2018

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Background: The management of renal anemia in the pre-dialysis period has been remarkably improved by longacting erythropoiesis-stimulating agents (ESA). However, many incident dialysis patients cannot achieve target hemoglobin (Hb) levels (> 10 g/dL) and sometimes require blood transfusions. Anemia at the time of dialysis initiation is reportedly correlated with cardiomegaly and early cardiovascular events. Here, we investigated whether this V-shaped depression in Hb level at dialysis initiation adversely affects short-term prognosis. Methods: The medical charts of 166 patients who underwent initial dialysis were retrospectively reviewed for Hb level, ESA treatment status, dry weight (DW), cardiothoracic rate (CTR), and brain natriuretic peptide (BNP) level at dialysis initiation and 1 year later. Patients were subdivided into three groups according to the tertile of Hb levels. The risk of mortality within 1 year after initiation was analyzed using multivariable-adjusted Cox proportional hazard model. Result: Mean Hb level at initiation was 8.6 ± 1.3 g/dL despite the administration of sufficient ESA. After initiation, Hb levels rapidly increased and the Hb time course showed a V-shape with the bottom at initiation. Hb level, CTR, and log BNP showed a significant negative correlation. The Hb level and CTR 1 year after initiation did not correlate with Hb levels at initiation. Lower Hb levels at initiation as a V-shaped depression do not adversely affect 1-year mortality rate by multivariable-adjusted Cox proportional hazard model. Conclusion: Hb level around dialysis initiation showed a V-shaped depression despite ESA use. Our findings suggest that the V-shaped Hb depression at initiation does not affect short-term prognosis.

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Section: Discussioncontrasting

confidence: 45%

Lower Hb at the initiation of dialysis does not adversely affect 1-year mortality rate

et al. 2018

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“…As well, the level of Hb was lower in our study (a) Cardiac cohort than levels reported in other Japanese cohorts. Specifically, two previous studies have reported a Hb level < 8.0 g/dL to be a significant prognostic factor at dialysis initiation [20,21]; the mean Hb level in our study cohort was above this cut-off value. Since 2007, Japanese nephrologists have been using long-active ESA (darbepoetin alfa, epoetin beta pegol) to treat patients with CKD, which has improved the management of renal anemia [22].…”

Section: Discussionmentioning

confidence: 38%

“…Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB Approval number: [14][15][16][17][18][19][20] and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.…”

Section: Acknowledgementsmentioning

confidence: 99%

Risk of cardiovascular mortality predicted by the serum calcium level and calcification score at the initiation of dialysis

Sato

Nagasawa²,

Saito

et al. 2018

Clin Exp Nephrol

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Background The relationship between serum corrected calcium (CCa) level and vessel calcification at dialysis initiation and survival has seldom been evaluated. Therefore, we evaluated the efficacy of CCa levels and the calcification score at the initiation of dialysis for predicting all-cause and cardiovascular (CV) mortality in patients with end-stage renal disease (ESRD). Methods The study group included 407 patients with ESRD, who started hemodialysis between January 2009 and December 2016 at the Red Cross Ishinomaki Hospital. The primary outcomes were the 1-and 3-year all-cause and CV mortality rate, with the association between CCa level and CVD-specific mortality evaluated using the Kaplan-Meier method and Cox proportional hazard regression analysis. Results Patients with a high initial CCa level were at higher risk for CVD-related, but not all-cause, mortality than patients with a low initial CCa level [hazard ratio (HR) 2.81; 95% confidence interval 1.05-7.55]. The HR for CVD-related mortality was also higher for patients with an Agatston vessel calcification score > 2000 (HR 13.9; 95% CI 1.63-118.2). Overall, the 3-year CVD-free rate was 88.2% (range 76.4-94.3%). Higher CCa level was associated with a higher Agatston score and cardiac valve calcification. Conclusion High serum CCa levels and an Agatston score > 2000 are independent risk factors of CVD mortality due to advanced vessel calcification.

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“…In support of this hypothesis, the results of recent studies showed that low Hb levels at hemodialysis initiation were a significant risk factor for coronary artery disease and cerebrovascular disease. 19 Based on the results of these previous studies and those of the present study, it is suggested that CKD patients need larger doses and/or more frequent injections of ESAs immediately before dialysis, even when being treated with long-acting ESAs.…”

Section: Discussionmentioning

confidence: 95%

Anemia Treatment by Erythropoiesis-stimulating Agents during the 6 Months before the Initiation of Hemodialysis: Comparison of Darbepoetin Alfa and Continuous Erythropoietin Receptor Activator

Yoshida

Hayashi

2016

Keio J. Med.

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Anemia in chronic kidney disease (CKD) is a risk factor for cardiovascular diseases and is treated by long-acting erythropoiesis-stimulating agents (ESAs). Although the results of previous studies haveshown that hemoglobin levels could not be maintained at the initiation of dialysis in CKD patients treated with recombinant human erythropoietin, it remains undetermined whether long-acting ESAs are effective in preventing the progression of anemia at the initiation of dialysis. In the present study, hemoglobin levels in 40 CKD patients treated with darbepoetin alfa (DA) and 15 CKD patients treated with a continuous erythropoietin receptor activator (CERA) were retrospectively compared during the 6 months period before the initiation of dialysis. Results showed that DA and CERA both maintained hemoglobin levels at around 10 g/dL from 6 months to 1 month before dialysis. However, hemoglobin levels at the initiation of dialysis significantly decreased to 9.1 ± 1.2 g/dL in the DA group and to 9.0 ± 1.0 g/dL in the CERA group. Although the total doses of ESAs used during the 6-month period were similar between the two groups, DA-treated CKD patients received subcutaneous injections more frequently than did patients treated with CERA. These results suggest that CKD patients require more intense ESA therapy to prevent a decline in hemoglobin levels at the initiation of dialysis, including those treated with long-acting ESAs. The results also raise the possibility that CERA is more useful than DA for reducing the number of injections during the pre-dialysis period.

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Relationship between anaemia management at haemodialysis initiation and patient prognosis

Cited by 13 publications

References 26 publications

Lower Hb at the initiation of dialysis does not adversely affect 1-year mortality rate

Lower Hb at the initiation of dialysis does not adversely affect 1-year mortality rate

Risk of cardiovascular mortality predicted by the serum calcium level and calcification score at the initiation of dialysis

Anemia Treatment by Erythropoiesis-stimulating Agents during the 6 Months before the Initiation of Hemodialysis: Comparison of Darbepoetin Alfa and Continuous Erythropoietin Receptor Activator

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