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Nephrol Dial Transplant. 2010 Aug;25(8):2702-10. doi: 10.1093/ndt/gfq073. Epub 2010 Feb 22.

Mortality in incident haemodialysis patients: time-dependent haemoglobin levels and erythropoiesis-stimulating agent dose are independent predictive factors in the ANSWER study.

Collaborators (293)

Abrigar P, Aguilera J, Aladrén MJ, Alcalá M, Alegre R, Aliaga MA, Almirall J, Alonso R, Alvarez R, Amador R, Amoedo ML, Andrés B, Angelet P, Antolín A, Arambarri M, Arenas MD, Argoitia A, Arranz M, Arraque A, Arribas G, Arrieta J, Arroyo MJ, Arteaga J, Aurrekoetxea B, Avilés B, Aznar Y, Barbosa F, Barril G, Basterrechea MA, Belart M, Beltran S, Bernal G, Bernat A, Besada ME, Betriu A, Biechy MM, Blanco A, Blasco A, Bolaños L, Bonilla B, Bordils A, Botella A, Bravo JJ, Calderón MT, Calls J, Calpe J, Calvar C, Calviño JA, Calvo E, Camacho G, Cardoso A, Caro P, Carretón MA, Cases A, Castellano I, Castellote E, Causadias R, Ceballos M, Cebollada J, Cerezo S, Cid MC, Compte MT, Contreras J, Covarsi A, Craver L, Crespo A, Cruzado JM, Cubas A, Cuevas X, Cuxart M, Díaz AI, Díaz C, Díaz H, Diego J, Domínguez ML, Donapetry CA, Durán V, Fabado S, Fenollosa MA, Fernández E, Fernández EJ, Fernández J, Fernández JE, Fernández MA, Fernández MD, Fontseré N, Fort J, Fraile A, Fraile P, Franquelo R, Gago E, Galán MJ, Gallego A, Gámez A, Gámez C, García A, García C, García CM, García F, García I, García J, García JA, García JB, García M, García MJ, García MM, García MT, García O, García R, García SA, García Z, Garrigós E, Gauna R, Gil JM, Gil MT, Gimeno I, Giráldez JD, Gómez JR, Gonzalez MA, González A, González B, González FJ, González FM, González J, Goñi M, Gota R, Gracia MC, Granado I, Granda M, Grande J, Graña JM, Gruss E, Guerrero I, Guervós CS, Güimil MD, Guzmán A, Heral M, Heras M, Hernández J, Hernández MT, Herrero JA, Herrero JC, Hornos CJ, Iribar I, Irrizu JM, Jiménez M, Labrador PJ, Lago M, Lampreabe I, León B, Llópez R, Llopis A, Logroño JM, López D, López E, López F, López J, López JL, López M, López MO, López T, Lorenzo I, Lorenzo J, Lorenzo V, Macia MA, Marcas L, Marco J, Marigliano N, Marín A, Martín B, Martín F, Martín G, Martín J, Martín P, Martinez A, Martínez P, Massanet C, Matas M, Mateos P, Mateos P, Mauri JM, Medina ML, Miguel JL, Millán I, Miranda E, Mòdol J, Moina I, Molina P, Montenegro J, Montoyo C, Moragrega B, Moreno MV, Moreno R, Mouzo R, Muñiz ML, Muñoz AB, Muñoz C, Muñoz JM, Muray S, Naranjo J, Naranjo M, Navarro M, Navarro MJ, Novillos R, Núñez J, Oleo P, Olivares J, Oliver JA, Ordoñez R, Ortega M, Ortí MD, Osorio JM, Otero A, Palma A, Pastor JM, Payán J, Pazos B, Pérez A, Pérez C, Pérez MA, Pérez R, Peris A, Picazo M, Pifarré M, Pino MD, Piñera VC, Pizarro JL, Pons M, Portoles JM, Pousa MM, Pozo C, Prados MC, Prados MD, Prieto M, Prim J, Ramos B, Ramos C, Ramos I, Ramos N, Rifà A, Rincón B, Rivas EA, Roca R, Rodríguez A, Rodríguez JR, Rodríguez MI, Rodríguez ML, Rodríguez P, Romero J, Rubio E, Ruiz A, Ruiz AM, Ruiz J, Ruiz JE, Ruiz P, Ruiz R, Sánchez C, Sánchez E, Sánchez F, Sánchez I, Sánchez M, Sánchez MC, Sánchez MD, Sánchez O, Sánchez P, Sánchez-Guisande D, Sancho J, Sans R, Santamaría C, Sastre F, Serra M, Serra M, Serrano A, Sevilla M, Sierra T, Silgado G, Sobrado J, Soldevila A, Soler JM, Tallón S, Tato A, Toledo A, Tornero F, Torregrosa I, Torres G, Usón J, Valdés J, Valera A, Valverde V, Vera M, Vidaur F, Viladoms J, Villaverde MT.

Author information

1
Servicio de Nefrologia, Hospital Vall d'Hebron, Barcelona, Spain. 9159jfr@comb.es

Abstract

BACKGROUND:

Although the association between low haemoglobin levels and mortality is well established in haemodialysis patients, data are conflicting regarding levels >12 g/dl. In addition, divergent results have been reported on the relation between erythropoiesis-stimulating agents (ESAs) and mortality.

METHODS:

This was a multicentre, observational, prospective, 24-month study, which recruited Spanish incident haemodialysis patients (N = 2310). Univariate and multivariate time-dependent Cox regression models examined the longitudinal association of mortality with haemoglobin and ESA dose; adjustment was made for iron deficiency and other confounders.

RESULTS:

After adjusting for age, functional status, body mass index, albumin levels, catheter as vascular access, previous history of cardiovascular disease, neoplasia, and ESA dose, mortality decreased with increasing haemoglobin. Adjusted hazard ratios relative to the reference category (11-12 g/dl) and 95% confidence intervals were: 1.36 (1.01-1.86) for <or=10 g/dl, 1.03 (0.75-1.42) for 10-11 g/dl, 0.93 (0.68-1.26) for 12-13 g/dl and 0.69 (0.49-0.97) for >13 g/dl. Independent of haemoglobin, patients on sustained ESA doses of 1-4000 IU/week and 8001-16 000 IU/week had better survival than non-treated (reference) patients, with adjusted hazard ratios of 0.61 (0.41-0.90) and 0.68 (0.49-0.94), respectively. No significant difference was found for doses of 4001-8000 IU/week or >16,000 IU/week, adjusted hazard ratios of 0.87 (0.63-1.20) and 0.89 (0.63-1.28), respectively.

CONCLUSIONS:

Higher haemoglobin levels are associated with lower mortality in Spanish incident haemodialysis patients, regardless of ESA dose, comorbidity, vascular access or malnutrition. No increase in mortality occurs for high ESA doses, independent of haemoglobin levels.

PMID:
20176608
DOI:
10.1093/ndt/gfq073
[Indexed for MEDLINE]

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