Hemoglobin Variability Is Associated with Nutritional Status in Hemodialysis Patients Undergoing Darbepoetin-Alfa Treatment

作者：Juyoung Jung, Dong-Jin Oh, Hye Min Choi, Young Eun Kwon, S. Baeg · 发表于：Journal of the American Society of Nephrology · 年份：2023 · DOI：10.1681/asn.20233411s1358c · 被引用次数：1

Background: Target hemoglobin level is suggested in the management of chronic kidney disease. However, hemoglobin levels often fall below or exceed the target range. Past retrospective cohort studies of patients undergoing hemodialysis with conventional short-acting erythropoiesis stimulating agents found that hemoglobin level fluctuations predicted mortality and cardiovascular adverse events; thereafter long-acting agents have been widely available. Methods: We adopted Cox regression models to evaluate associations between hemoglobin level variability and all-cause death, hospitalization, and cardiovascular, thrombotic, or infectious adverse event outcomes in 3,063 hemodialysis patients’ data from the Japanese Dialysis Outcomes and Practice Patterns Study from 2012 to 2018. Results: All-cause mortality was lowest in the first quartile and tended to be higher in the groups with greater hemoglobin variability (hazard ratio: 95% confidence interval for the fourth quartile of an absolute value of hemoglobin variability: 1.44 [0.99–2.08], p for trend = 0.056). Intriguingly, infectious event incidence was higher than the first quartile for the second through fourth quartiles (p for trend <0.01). The association was more pronounced in patients with lower serum ferritin levels or with iron supplementation. However, cardiovascular and thrombotic event incidence was not associated with hemoglobin variability. Conclusions: Maintenance hemodialysis patients on erythropoiesis stimulating...