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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

1
Medical Technology and Practice Patterns Institute, 5272 River Road, Suite 500, Bethesda, MD 20816, USA.
2
VA NY Harbor Healthcare System, 423 East 23rd St New York, NY 10010, USA.
3
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.

Abstract

BACKGROUND/AIMS:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

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

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