Reference

1. Hemoglobin Predicts Long-term Survival in Dialysis Patients Hemoglobin predicts long-term survival in dialysis patients: a 15-year single-center longitudinal study and a correlation trend between prealbumin and hemoglobin Reference Avram MM, et al. Hemoglobin predicts long-term survival in dialysis patients: a 15-year single-center longitudinal study and a correlation trend between prealbumin and hemoglobin. Kidney Int. 2003;64(Suppl.87):S6–S11.

2. Background Patients on dialysis have a higher mortality rate than the general population. A very common complication of uremia in dialysis patients is anemia. There are huge benefits of anemia correction with human recombinant erythropoietin (rHuEPO). However, the ideal levels of hemoglobin in dialysis patients remain blurred. In this study, the association of hemoglobin at initiation of trial is done with long-term survival in hemodialysis and peritoneal dialysis

3. Aim To evaluate the association of enrollment hemoglobin with long-term survival in hemodialysis (HD) and peritoneal dialysis (PD) patients and the inter-relationship between prealbumin and anemia and their impact on mortality.

4. Method Study population: 529 HD and 326 PD patients were enrolled in this trial, which was initiated in 1987 and continued till 2003. The demographical and clinical data were collected which included age, race, sex, gender, diabetic status, etiology of end-stage renal disease (ESRD), total months of dialysis therapy initiation and seropositive to HIV. Treatment regimen: The HD patients were treated with volumetric ultrafiltration control and dialysate (bicarbonate based). Cellulose-based membranes (predominantly cellulose acetate and cellulose triacetate) were used prior to 1998 for more than 95% of all treatments. Thereafter, all patients were switched to polysulfone membranes. Prior to 1992, most patients were treated with continuous ambulatory peritoneal dialysis and received four 2-L LVP solution exchanges per day. After 1992, the PD prescription was to achieve a weekly target of 1.7 Kt/V, which was further increased to 2.1 Kt/V.

5. Results In the HD patients, causes of ESRD were listed as follows: diabetes (40%), hypertension (31%), glomerulonephritis (11%), polycystic kidney disease (4%), obstruction (2%) and unknown (11%). A total of 54.6% HD patients have died. Patients were stratified by hemoglobin level ≥12 g/dl and more than 12 g/dl. Survival of patients with initial hemoglobin more than 12 g/dl was better than that of patients with hemoglobin less than 12 g/dl. However, a subgroup analysis showed that this was only true in case of non-diabetic patients.

6. In patients with PD, the causes of ESRD were diabetes (35%), hypertension (30%), glomerulonephritis (9%), polycystic kidney disease (3%), obstruction (3%) and unknown (13%). 54% of the PD patients have died. Peritoneal dialysis patients were grouped by hemoglobin levels: ≥12 and <12 g/dL. The survival of PD patients with enrollment hemoglobin less than 12 g/dl was better than that of patients with hemoglobin more than 12 g/dl. Hemoglobin was weekly correlated to hemoglobin in both HD and PD patients.

7. Conclusion Hemoglobin levels of more than 12 g/dl had better survival levels than patients with lower hemoglobin levels. Hence it can be concluded that hemoglobin levels influence the survival of patients in HD and PD. Higher the hemoglobin levels, better the survival rate in patients with HD and PD.