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BMJ. 2009 Oct 23;339:b4018. doi: 10.1136/bmj.b4018.

Mortality in renal transplant recipients given erythropoietins to increase haemoglobin concentration: cohort study.

Author information

1
Core Unit of Medical Statistics and Informatics, Medical University of Vienna, 1090 Vienna, Austria.

Abstract

OBJECTIVE:

To determine the optimal range of increase in haemoglobin concentration with treatment with erythropoietins that is safe and is not associated with mortality.

DESIGN:

Retrospective cohort study. The analysis was adjusted for several covariables with Cox regression analysis with spline functions. Use of erythropoietins, haemoglobin concentration, and covariables were included in a time varying manner; variable selection was based on the purposeful selection algorithm.

SETTING:

Transplantation centres in Austria.

PARTICIPANTS:

1794 renal transplant recipients recorded in the Austrian Dialysis and Transplant Registry who received a transplant between 1 January 1992 and 31 December 2004 and survived at least three months.

MAIN OUTCOME MEASURES:

Survival time and haemoglobin concentration after treatment with erythropoietins.

RESULTS:

The prevalence of use of erythropoietins has increased over the past 15 years to 25%. Unadjusted extended Kaplan-Meier analysis suggests higher mortality in patients treated with erythropoietins, in whom 10 year survival was 57% compared with 78% in those not treated with erythropoietins (P<0.001). In the treated patients there were 5.4 events/100 person years, compared with 2.6 events/100 person years in those not treated (P<0.001). After adjustment for confounding by indication, comorbidities, comedication, and laboratory readings, haemoglobin concentrations >125 g/l were associated with increased mortality in treated patients (hazard ratio 2.8 (95% confidence interval 1.0 to 7.9) for haemoglobin concentration 140 g/l v 125 g/l), but not in those not treated (0.7, 0.4 to 1.5). When haemoglobin concentrations were 147 g/l or above, patients treated with erythropoietins showed significantly higher mortality than those who were not treated (3.0, 1.0 to 9.4).

CONCLUSION:

Increasing haemoglobin concentrations to above 125 g/l with erythropoietins in renal transplant recipients is associated with an increase in mortality. This increase was significant at concentrations above 140 g/l.

PMID:
19854839
PMCID:
PMC2766440
[Indexed for MEDLINE]
Free PMC Article

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