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Age and anemia management: relationship of hemoglobin levels with mortality might differ between elderly and nonelderly hemodialysis patients

BACKGROUND: The elderly hemodialyzed population is growing. However, little is known about the relationship between hemoglobin level and survival according to age. We investigated the effect of age on the relationship between hemoglobin and survival within the Japan Dialysis Outcomes and Practice Pa...

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Autores principales: Hanafusa, Norio, Nomura, Takanobu, Hasegawa, Takeshi, Nangaku, Masaomi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240181/
https://www.ncbi.nlm.nih.gov/pubmed/25150218
http://dx.doi.org/10.1093/ndt/gfu272
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author Hanafusa, Norio
Nomura, Takanobu
Hasegawa, Takeshi
Nangaku, Masaomi
author_facet Hanafusa, Norio
Nomura, Takanobu
Hasegawa, Takeshi
Nangaku, Masaomi
author_sort Hanafusa, Norio
collection PubMed
description BACKGROUND: The elderly hemodialyzed population is growing. However, little is known about the relationship between hemoglobin level and survival according to age. We investigated the effect of age on the relationship between hemoglobin and survival within the Japan Dialysis Outcomes and Practice Patterns Study (DOPPS) cohort. METHODS: We enrolled the entire Japan DOPPS phases 3 and 4 population. Patients were divided by the age of 75 years into two groups. Cox's proportional hazard model was used with hemoglobin at every 4 months treated as a time-dependent variable. The interaction of age and hemoglobin was analyzed. RESULTS: We included 3341 patients in the analyses. The primary outcome occurred in 567 patients during the median follow-up of 2.64 years. Hemoglobin of entire population was 10.3 ± 1.3 g/dL. The median of epoetin dose was 3000 IU/week. Interaction was found between ages stratified by the age of 75 years and hemoglobin values (P = 0.045) with use of Cox's proportional hazard model. The nonelderly population had poorer prognosis with hemoglobin <10 g/dL, while elderly population only with hemoglobin <9 g/dL. For both hemoglobin strata <9, ≥9 and <10 g/dL, interactions between age and hemoglobin were significant. Subgroup analysis indicated that interaction between age and Hb levels was observed only in the nondiabetic nephropathy group. Several sensitivity analyses demonstrated a similar trend with the original analyses and reinforced the robustness. CONCLUSIONS: The elderly population might tolerate low hemoglobin levels. Our findings open the way for further investigation of individualized anemia management.
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spelling pubmed-42401812014-11-21 Age and anemia management: relationship of hemoglobin levels with mortality might differ between elderly and nonelderly hemodialysis patients Hanafusa, Norio Nomura, Takanobu Hasegawa, Takeshi Nangaku, Masaomi Nephrol Dial Transplant CLINICAL SCIENCE BACKGROUND: The elderly hemodialyzed population is growing. However, little is known about the relationship between hemoglobin level and survival according to age. We investigated the effect of age on the relationship between hemoglobin and survival within the Japan Dialysis Outcomes and Practice Patterns Study (DOPPS) cohort. METHODS: We enrolled the entire Japan DOPPS phases 3 and 4 population. Patients were divided by the age of 75 years into two groups. Cox's proportional hazard model was used with hemoglobin at every 4 months treated as a time-dependent variable. The interaction of age and hemoglobin was analyzed. RESULTS: We included 3341 patients in the analyses. The primary outcome occurred in 567 patients during the median follow-up of 2.64 years. Hemoglobin of entire population was 10.3 ± 1.3 g/dL. The median of epoetin dose was 3000 IU/week. Interaction was found between ages stratified by the age of 75 years and hemoglobin values (P = 0.045) with use of Cox's proportional hazard model. The nonelderly population had poorer prognosis with hemoglobin <10 g/dL, while elderly population only with hemoglobin <9 g/dL. For both hemoglobin strata <9, ≥9 and <10 g/dL, interactions between age and hemoglobin were significant. Subgroup analysis indicated that interaction between age and Hb levels was observed only in the nondiabetic nephropathy group. Several sensitivity analyses demonstrated a similar trend with the original analyses and reinforced the robustness. CONCLUSIONS: The elderly population might tolerate low hemoglobin levels. Our findings open the way for further investigation of individualized anemia management. Oxford University Press 2014-12 2014-08-21 /pmc/articles/PMC4240181/ /pubmed/25150218 http://dx.doi.org/10.1093/ndt/gfu272 Text en © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle CLINICAL SCIENCE
Hanafusa, Norio
Nomura, Takanobu
Hasegawa, Takeshi
Nangaku, Masaomi
Age and anemia management: relationship of hemoglobin levels with mortality might differ between elderly and nonelderly hemodialysis patients
title Age and anemia management: relationship of hemoglobin levels with mortality might differ between elderly and nonelderly hemodialysis patients
title_full Age and anemia management: relationship of hemoglobin levels with mortality might differ between elderly and nonelderly hemodialysis patients
title_fullStr Age and anemia management: relationship of hemoglobin levels with mortality might differ between elderly and nonelderly hemodialysis patients
title_full_unstemmed Age and anemia management: relationship of hemoglobin levels with mortality might differ between elderly and nonelderly hemodialysis patients
title_short Age and anemia management: relationship of hemoglobin levels with mortality might differ between elderly and nonelderly hemodialysis patients
title_sort age and anemia management: relationship of hemoglobin levels with mortality might differ between elderly and nonelderly hemodialysis patients
topic CLINICAL SCIENCE
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240181/
https://www.ncbi.nlm.nih.gov/pubmed/25150218
http://dx.doi.org/10.1093/ndt/gfu272
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