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Intra-Dialytic Hemoglobin Changes and Cardiovascular Events: A Cohort Study on Dialysis Outcomes and Practice
Takashi Hara1,2, Miho Kimachi1, Tatsuyoshi Ikenoue3
1Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
Insights
Intra-dialytic hemoglobin changes during hemodialysis (HD) impact cardiovascular events. Both high and low hemoglobin concentration ratios indicate an increased risk of major adverse cardiovascular events (MACEs) in HD patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Research
Background:
- Hemodialysis (HD) ultrafiltration causes hemoconcentration.
- Limited understanding of intra-dialytic hemoglobin changes and cardiovascular events.
- Need to investigate the link between intra-dialytic hemoglobin shifts and cardiovascular outcomes in HD patients.
Purpose of the Study:
- To examine the association between intra-dialytic hemoglobin concentration changes and major adverse cardiovascular events (MACEs).
- To identify risks associated with hemoglobin fluctuations during hemodialysis.
- To inform clinical practice regarding cardiovascular risk management in HD patients.
Main Methods:
- Prospective cohort study using Japanese Dialysis Outcomes and Practice Pattern Study data (phases 4 and 5).
- Predictor: Ratio of post-dialysis to pre-dialysis hemoglobin (post-Hb/pre-Hb).
- Outcome: Major adverse cardiovascular events (MACEs); analyzed using Cox models.
Main Results:
- 145/865 patients experienced MACEs over 2.6 years.
- U-shaped association found between post-Hb/pre-Hb ratio and MACEs.
- Elevated MACE risk observed at both low (<1.0) and high (≥1.2) post-Hb/pre-Hb ratios compared to the reference (≥1.1 to <1.2).
Conclusions:
- Both excessive hemoconcentration and insufficient hemoconcentration during HD are linked to increased MACE risk.
- Intra-dialytic hemoglobin concentration changes are significant predictors of cardiovascular events in HD patients.
- Monitoring hemoglobin dynamics during hemodialysis is crucial for cardiovascular risk assessment.
Background:
Ultrafiltration during hemodialysis (HD) causes hemoconcentration. Little is known about the relationships between intra-dialytic changes in hemoglobin concentration and cardiovascular events. Thus, this study aimed to elucidate the relationships between intra-dialytic changes in hemoglobin concentration and cardiovascular events among HD patients.
Methods:
This prospective cohort study was based on the Japanese Dialysis Outcomes and Practice Pattern Study phases 4 and 5. The predictor was the ratio of post-dialysis hemoglobin concentration to pre-dialysis hemoglobin concentration (post-Hb/pre-Hb) at baseline. The primary outcome was major adverse cardiovascular events (MACEs). Hazard ratios (HRs) were estimated using a Cox model for the association between post-Hb/pre-Hb and MACEs, adjusting for potential confounders.
Results:
A total of 865 patients were enrolled. During a median follow-up of 2.6 years, 145 (16.8%) patients developed MACEs. Patients were divided into 4 categories according to baseline post-Hb/pre-Hb (<1.0, ≥1.0 to <1.1, ≥1.1 to <1.2, and ≥1.2). The multivariable-adjusted HRs for MACEs were 1.69 (95% CI 1.36-2.10), 1.29 (95% CI 1.10-1.51), and 1.31 (95% CI 1.02-1.68) in patients with post-Hb/pre-Hb ratios of <1.0, ≥1.0 to <1.1, and ≥1.2, respectively, compared with the reference post-Hb/pre-Hb ratio of ≥1.1 to <1.2. Cubic spline analyses revealed a U-shaped association between post-Hb/pre-Hb and MACEs.
Conclusion:
High and low intra-dialytic changes in hemoglobin concentration are associated with a high risk of MACEs in patients undergoing HD.
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