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Variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study


Background: Given regulatory and reimbursement changes in anemia management, we examined hemoglobin variability in a contemporary cohort of maintenance hemodialysis patients. Materials and methods: The study population included > 200,000 hemodialysis patients with Medicare parts A and B as primar...

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Autores principales: Gilbertson, David T., Hu, Yan, Peng, Yi, Maroni, Bradley J., Wetmore, James B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dustri-Verlag Dr. Karl Feistle 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653974/
https://www.ncbi.nlm.nih.gov/pubmed/28899480
http://dx.doi.org/10.5414/CN109031
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author Gilbertson, David T.
Hu, Yan
Peng, Yi
Maroni, Bradley J.
Wetmore, James B.
author_facet Gilbertson, David T.
Hu, Yan
Peng, Yi
Maroni, Bradley J.
Wetmore, James B.
author_sort Gilbertson, David T.
collection PubMed
description Background: Given regulatory and reimbursement changes in anemia management, we examined hemoglobin variability in a contemporary cohort of maintenance hemodialysis patients. Materials and methods: The study population included > 200,000 hemodialysis patients with Medicare parts A and B as primary payer on October 1, 2012. Based on 25(th) and 75(th) percentiles, monthly hemoglobin values were categorized as low, intermediate, or high. Six variability categories were created by patterns during the 6-month observation period. Stable categories were: always-low, always-intermediate, always-high; variable patterns were: varying between low and intermediate, intermediate and high, low and high (most-variable). Cox proportional hazard models were used to assess the association between hemoglobin variability and all-cause mortality or major adverse cardiac events (MACE). Results: The 25(th) and 75(th) hemoglobin percentiles were 10.2 and 11.5 g/dL, respectively, in 2012, vs. 11 and 12.5 g/dL in 2004. ESA doses were lower in all categories in 2012 and transfusion rates higher, particularly for always-low patients. Hemoglobin variability decreased modestly: in 2004, 6.0% were always-intermediate, vs. 9.5% in 2012. In 2012, more patients were always-high and fewer were most-variable. Mortality hazard ratios (HRs) were higher for patients with any low hemoglobin: always-low (HR, 95% CI: 2.07, 1.84 – 2.31), varying between low and intermediate (1.37, 1.29 – 1.45), and most-variable (1.23, 1.16 – 1.31); the pattern was similar for MACE. Conclusions: In 2012 vs. 2004, hemoglobin levels decreased, the range of levels narrowed, and variability decreased modestly; transfusions increased. The highest risk of mortality and MACE appeared to occur in patients with persistently low, rather than highly variable, hemoglobin levels.

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spelling pubmed-56539742017-11-02 Variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study
 Gilbertson, David T. Hu, Yan Peng, Yi Maroni, Bradley J. Wetmore, James B. Clin Nephrol Research Article Background: Given regulatory and reimbursement changes in anemia management, we examined hemoglobin variability in a contemporary cohort of maintenance hemodialysis patients. Materials and methods: The study population included > 200,000 hemodialysis patients with Medicare parts A and B as primary payer on October 1, 2012. Based on 25(th) and 75(th) percentiles, monthly hemoglobin values were categorized as low, intermediate, or high. Six variability categories were created by patterns during the 6-month observation period. Stable categories were: always-low, always-intermediate, always-high; variable patterns were: varying between low and intermediate, intermediate and high, low and high (most-variable). Cox proportional hazard models were used to assess the association between hemoglobin variability and all-cause mortality or major adverse cardiac events (MACE). Results: The 25(th) and 75(th) hemoglobin percentiles were 10.2 and 11.5 g/dL, respectively, in 2012, vs. 11 and 12.5 g/dL in 2004. ESA doses were lower in all categories in 2012 and transfusion rates higher, particularly for always-low patients. Hemoglobin variability decreased modestly: in 2004, 6.0% were always-intermediate, vs. 9.5% in 2012. In 2012, more patients were always-high and fewer were most-variable. Mortality hazard ratios (HRs) were higher for patients with any low hemoglobin: always-low (HR, 95% CI: 2.07, 1.84 – 2.31), varying between low and intermediate (1.37, 1.29 – 1.45), and most-variable (1.23, 1.16 – 1.31); the pattern was similar for MACE. Conclusions: In 2012 vs. 2004, hemoglobin levels decreased, the range of levels narrowed, and variability decreased modestly; transfusions increased. The highest risk of mortality and MACE appeared to occur in patients with persistently low, rather than highly variable, hemoglobin levels.
 Dustri-Verlag Dr. Karl Feistle 2017-11 2017-09-07 /pmc/articles/PMC5653974/ /pubmed/28899480 http://dx.doi.org/10.5414/CN109031 Text en © Dustri-Verlag Dr. K. Feistle http://creativecommons.org/licenses/by/2.5/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Gilbertson, David T.
Hu, Yan
Peng, Yi
Maroni, Bradley J.
Wetmore, James B.
Variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study

title Variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study

title_full Variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study

title_fullStr Variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study

title_full_unstemmed Variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study

title_short Variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study

title_sort variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study

topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653974/
https://www.ncbi.nlm.nih.gov/pubmed/28899480
http://dx.doi.org/10.5414/CN109031
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