The Korean Clinical Research Center for End-Stage Renal Disease Study Validates the Association of Hemoglobin and Erythropoiesis-Stimulating Agent Dose with Mortality in Hemodialysis Patients.
Anemia is an important risk factor for mortality in hemodialysis (HD) patients. However, higher hemoglobin (Hb) is not necessarily better, as seen in several studies. This study aimed to validate the clinical use of an Hb target of 10-11 g/dL in Korean HD patients.A total of 1,276 HD patients from t...
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| Format: | Article |
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Public Library of Science (PLoS)
2015-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC4599895?pdf=render |
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| author | Owen Kwon Hye Min Jang Hee-Yeon Jung Yon Su Kim Shin-Wook Kang Chul Woo Yang Nam-Ho Kim Ji-Young Choi Jang-Hee Cho Chan-Duck Kim Yong-Lim Kim Sun-Hee Park Clinical Research Center for End-Stage Renal Disease (CRC- ESRD) Investigators |
| author_facet | Owen Kwon Hye Min Jang Hee-Yeon Jung Yon Su Kim Shin-Wook Kang Chul Woo Yang Nam-Ho Kim Ji-Young Choi Jang-Hee Cho Chan-Duck Kim Yong-Lim Kim Sun-Hee Park Clinical Research Center for End-Stage Renal Disease (CRC- ESRD) Investigators |
| author_sort | Owen Kwon |
| collection | DOAJ |
| description | Anemia is an important risk factor for mortality in hemodialysis (HD) patients. However, higher hemoglobin (Hb) is not necessarily better, as seen in several studies. This study aimed to validate the clinical use of an Hb target of 10-11 g/dL in Korean HD patients.A total of 1,276 HD patients from the Clinical Research Center (CRC) for End-Stage Renal Disease (ESRD) were investigated in a prospective observational study. Cox proportional hazard analysis was conducted for each category of time-dependent Hb level and erythropoiesis-stimulating agent (ESA) dose, with subgroup analysis stratified by age and diabetes status.Using a reference Hb level of 10-11 g/dL, the hazard ratios (HRs) of death were 5.12 (95% confidence interval [CI], 2.62-10.02, P <0.05) for Hb level <9.0 g/dL, and 2.03 (CI, 1.16-3.69, P <0.05) for Hb level 9.0-10.0 g/dL, after adjustment for multiple clinical variables. However, an Hb level ≥11 g/dL was not associated with decreased mortality risk. In an adjusted model categorized by Hb and ESA dose, the risk of death at an Hb level <10 g/dL and a higher dose of ESA (≥126 U/kg/week) had an HR of 2.25 (CI, 1.03-4.92, P <0.05), as compared to Hb level 10-11 g/dL and a lower dose of ESA. In subgroup analysis, those older than 65 years or who were diabetic had greater risk for mortality only in Hb category <9.0 g/dL. However, there was no significant interaction between age or diabetes status and Hb.Using CRC-ESRD data, we validated the association between Hb and ESA dose and mortality in Korean HD patients. The clinical practice target of an Hb of 10-11 g/dL before the new KDIGO guideline era seems reasonable considering its survival benefit in HD patients. |
| first_indexed | 2024-04-14T02:14:23Z |
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| institution | Directory Open Access Journal |
| issn | 1932-6203 |
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| last_indexed | 2024-04-14T02:14:23Z |
| publishDate | 2015-01-01 |
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| spelling | doaj.art-43cfd795f2d04362bd9a8216c4e432f32022-12-22T02:18:19ZengPublic Library of Science (PLoS)PLoS ONE1932-62032015-01-011010e014024110.1371/journal.pone.0140241The Korean Clinical Research Center for End-Stage Renal Disease Study Validates the Association of Hemoglobin and Erythropoiesis-Stimulating Agent Dose with Mortality in Hemodialysis Patients.Owen KwonHye Min JangHee-Yeon JungYon Su KimShin-Wook KangChul Woo YangNam-Ho KimJi-Young ChoiJang-Hee ChoChan-Duck KimYong-Lim KimSun-Hee ParkClinical Research Center for End-Stage Renal Disease (CRC- ESRD) InvestigatorsAnemia is an important risk factor for mortality in hemodialysis (HD) patients. However, higher hemoglobin (Hb) is not necessarily better, as seen in several studies. This study aimed to validate the clinical use of an Hb target of 10-11 g/dL in Korean HD patients.A total of 1,276 HD patients from the Clinical Research Center (CRC) for End-Stage Renal Disease (ESRD) were investigated in a prospective observational study. Cox proportional hazard analysis was conducted for each category of time-dependent Hb level and erythropoiesis-stimulating agent (ESA) dose, with subgroup analysis stratified by age and diabetes status.Using a reference Hb level of 10-11 g/dL, the hazard ratios (HRs) of death were 5.12 (95% confidence interval [CI], 2.62-10.02, P <0.05) for Hb level <9.0 g/dL, and 2.03 (CI, 1.16-3.69, P <0.05) for Hb level 9.0-10.0 g/dL, after adjustment for multiple clinical variables. However, an Hb level ≥11 g/dL was not associated with decreased mortality risk. In an adjusted model categorized by Hb and ESA dose, the risk of death at an Hb level <10 g/dL and a higher dose of ESA (≥126 U/kg/week) had an HR of 2.25 (CI, 1.03-4.92, P <0.05), as compared to Hb level 10-11 g/dL and a lower dose of ESA. In subgroup analysis, those older than 65 years or who were diabetic had greater risk for mortality only in Hb category <9.0 g/dL. However, there was no significant interaction between age or diabetes status and Hb.Using CRC-ESRD data, we validated the association between Hb and ESA dose and mortality in Korean HD patients. The clinical practice target of an Hb of 10-11 g/dL before the new KDIGO guideline era seems reasonable considering its survival benefit in HD patients.http://europepmc.org/articles/PMC4599895?pdf=render |
| spellingShingle | Owen Kwon Hye Min Jang Hee-Yeon Jung Yon Su Kim Shin-Wook Kang Chul Woo Yang Nam-Ho Kim Ji-Young Choi Jang-Hee Cho Chan-Duck Kim Yong-Lim Kim Sun-Hee Park Clinical Research Center for End-Stage Renal Disease (CRC- ESRD) Investigators The Korean Clinical Research Center for End-Stage Renal Disease Study Validates the Association of Hemoglobin and Erythropoiesis-Stimulating Agent Dose with Mortality in Hemodialysis Patients. PLoS ONE |
| title | The Korean Clinical Research Center for End-Stage Renal Disease Study Validates the Association of Hemoglobin and Erythropoiesis-Stimulating Agent Dose with Mortality in Hemodialysis Patients. |
| title_full | The Korean Clinical Research Center for End-Stage Renal Disease Study Validates the Association of Hemoglobin and Erythropoiesis-Stimulating Agent Dose with Mortality in Hemodialysis Patients. |
| title_fullStr | The Korean Clinical Research Center for End-Stage Renal Disease Study Validates the Association of Hemoglobin and Erythropoiesis-Stimulating Agent Dose with Mortality in Hemodialysis Patients. |
| title_full_unstemmed | The Korean Clinical Research Center for End-Stage Renal Disease Study Validates the Association of Hemoglobin and Erythropoiesis-Stimulating Agent Dose with Mortality in Hemodialysis Patients. |
| title_short | The Korean Clinical Research Center for End-Stage Renal Disease Study Validates the Association of Hemoglobin and Erythropoiesis-Stimulating Agent Dose with Mortality in Hemodialysis Patients. |
| title_sort | korean clinical research center for end stage renal disease study validates the association of hemoglobin and erythropoiesis stimulating agent dose with mortality in hemodialysis patients |
| url | http://europepmc.org/articles/PMC4599895?pdf=render |
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