The following is a summary of “Hemoglobin and Clinical Outcomes in Hemodialysis: An Analysis of US Medicare Data From 2018 to 2020,” published in the February 2023 issue of Kidney Medicine by Young et al.
Maintenance dialysis users still face difficulties controlling their anemia. Using data-rich Medicare sources, researchers analyzed the connection between hemoglobin and several outcome and usage metrics to provide up-to-date information in this field. Medicare claims and information from the CROWN database (Consolidated Renal Operations in a Web-enabled Network) were used for observational cohort research. Researchers looked at data from 371,250 regular hemodialysis patients, which totaled 3,326,072 patient months in 2019. Researchers looked at numerous outcomes in the month after the exposure was measured, including mortality, all-cause hospitalization, cause-specific hospitalization, and ED visits. Researchers used Cox regression to determine both raw and adjusted (for demographics and comorbid conditions) hazard ratios for each month of observation.
In 40% of samples, the hemoglobin level was 10.5 g/dL. Researchers found an inverse association between mortality and hemoglobin measured over a range from <9 g/dL (HR, 2.53; 95% CI, 2.45-2.61; P < 0.0001, reference = 10.5-11 g/dL) to 11-11.5 g/dL (HR, 0.92; 95% CI, 0.89-0.96; P < 0.0001). The chance of dying increased as hemoglobin levels was>11.5 g/dL. Hospitalization for any reason, hospitalization for infections (including the 2019 coronavirus outbreak), and visits to the emergency room all decreased with increasing hemoglobin concentration, with the protective effect plateauing at around 11.5–12 g/dL.
The found connections should be interpreted cautiously, as has been the case with other observational research. Consistent with prior observational studies that often used more prolonged exposure and follow-up intervals, greater hemoglobin concentrations were associated with improved clinical outcomes in a large US hemodialysis cohort. Hemoglobin levels > 11.5 g/dL were associated with an increased mortality risk, which aligns with results from erythropoiesis-stimulating drug clinical trials. Hemoglobin tests may capture unmeasured parts of patient risk due to the favorable short-term benefits associated with greater concentrations.
Source: sciencedirect.com/science/article/pii/S2590059522002114