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

Clinical Research Center for End-Stage Renal Disease (CRC- ESRD) Investigators

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background 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. Methods 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. Results 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. Conclusion 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.

Original languageEnglish
Article numbere0140241
JournalPloS one
Volume10
Issue number10
DOIs
Publication statusPublished - 2015 Oct 9

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Hematinics
erythropoiesis
hemodialysis
kidney diseases
Chronic Kidney Failure
Renal Dialysis
hemoglobin
Hemoglobins
Mortality
dosage
Research
confidence interval
Hazards
Confidence Intervals
Medical problems
diabetes
death
hazard characterization
observational studies

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

@article{448358338f1c430a853e9e28fea52d83,
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",
abstract = "Background 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. Methods 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. Results 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. Conclusion 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.",
author = "{Clinical Research Center for End-Stage Renal Disease (CRC- ESRD) Investigators} and Owen Kwon and Jang, {Hye Min} and Jung, {Hee Yeon} and Kim, {Yon Su} and Kang, {Shin Wook} and Yang, {Chul Woo} and Kim, {Nam Ho} and Choi, {Ji Young} and Cho, {Jang Hee} and Kim, {Chan Duck} and Kim, {Yong Lim} and Park, {Sun Hee} and Do, {J. Y.} and Song, {S. H.} and Kim, {S. E.} and Kim, {S. H.} and Kim, {Y. H.} and Lee, {J. S.} and Jin, {H. J.} and Lim, {C. S.} and Lee, {J. P.} and Chang, {J. H.} and Yoo, {T. H.} and Park, {J. T.} and Oh, {H. J.} and Park, {H. C.} and Chang, {T. I.} and Ryu, {D. R.} and Oh, {D. J.} and Chang, {Y. S.} and Kim, {Y. O.} and Kim, {S. H.} and Jin, {D. C.} and Kim, {Y. K.} and Kim, {H. Y.} and W. Kim and Lee, {K. W.} and Lee, {C. S.}",
year = "2015",
month = "10",
day = "9",
doi = "10.1371/journal.pone.0140241",
language = "English",
volume = "10",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "10",

}

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. / Clinical Research Center for End-Stage Renal Disease (CRC- ESRD) Investigators.

In: PloS one, Vol. 10, No. 10, e0140241, 09.10.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 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

AU - Clinical Research Center for End-Stage Renal Disease (CRC- ESRD) Investigators

AU - Kwon, Owen

AU - Jang, Hye Min

AU - Jung, Hee Yeon

AU - Kim, Yon Su

AU - Kang, Shin Wook

AU - Yang, Chul Woo

AU - Kim, Nam Ho

AU - Choi, Ji Young

AU - Cho, Jang Hee

AU - Kim, Chan Duck

AU - Kim, Yong Lim

AU - Park, Sun Hee

AU - Do, J. Y.

AU - Song, S. H.

AU - Kim, S. E.

AU - Kim, S. H.

AU - Kim, Y. H.

AU - Lee, J. S.

AU - Jin, H. J.

AU - Lim, C. S.

AU - Lee, J. P.

AU - Chang, J. H.

AU - Yoo, T. H.

AU - Park, J. T.

AU - Oh, H. J.

AU - Park, H. C.

AU - Chang, T. I.

AU - Ryu, D. R.

AU - Oh, D. J.

AU - Chang, Y. S.

AU - Kim, Y. O.

AU - Kim, S. H.

AU - Jin, D. C.

AU - Kim, Y. K.

AU - Kim, H. Y.

AU - Kim, W.

AU - Lee, K. W.

AU - Lee, C. S.

PY - 2015/10/9

Y1 - 2015/10/9

N2 - Background 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. Methods 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. Results 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. Conclusion 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.

AB - Background 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. Methods 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. Results 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. Conclusion 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.

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SN - 1932-6203

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