Send to

Choose Destination
J Endocrinol Diabetes. 2014;1(2). doi: 10.15226/2374-6890/1/2/00111.

Similar Outcomes for Two Anemia Treatment Strategies among Elderly Hemodialysis Patients with Diabetes.

Author information

Medical Technology and Practice Patterns Institute, 5272 River Road, Suite 500, Bethesda, MD 20816, USA.
VA NY Harbor Healthcare System, 423 East 23rd St New York, NY 10010, USA.
Departments of Epidemiology and Biostatistics, Harvard School of Public Health, Harvard-MIT Division of Health Sciences and Technology, 677 Huntington Avenue Boston, Massachusetts 02115 USA.



To compare mortality and cardiovascular risk in elderly dialysis patients with diabetes under two clinical strategies of anemia correction: maintaining hematocrit (Hct) between 34.5 and < 39.0% (high Hct strategy), and between 30.0 and <34.5% (low Hct strategy) using intravenous alpha epoetin.


Observational data were used to emulate a randomized trial in which diabetic patients who initiated hemodialysis in 2006-2008 were assigned to each anemia correction strategy. Inverse-probability weighting was used to adjust for measured time-dependent confounding.


Comparing high with low hematocrit strategy, the hazard ratio (95% confidence interval) was 1.07 (0.83, 1.38) for all-cause mortality and 1.00 (0.81, 1.24) for a composite mortality and cardiovascular endpoint.


Among a cohort of elderly hemodialysis patients with diabetes, no differences were found between the low and high hematocrit strategies. A lower target hematocrit - per current Food and Drug Administration (FDA) guidelines - appears to be as safe as higher targets among this population.


Cardiovascular outcomes; Diabetes; ESA; Epoetin; Hemodialysis; Inverse probability weighting; Marginal structural modeling; Mortality

Supplemental Content

Full text links

Icon for PubMed Central
Loading ...
Support Center