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Impact of hemoglobin variability on cardiovascular mortality in maintenance hemodialysis patients

  • Nephrology - Original Paper
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Abstract

Purpose

Although the association between anemia and cardiovascular mortality in hemodialysis patients is well established, whether hemoglobin variability (Hgb-Var) affects the prognosis remains unclear. We aimed to evaluate the association between Hgb-Var and cardiovascular mortality in Chinese hemodialysis patients.

Methods

This retrospective study included 252 patients starting hemodialysis in Xin Hua Hospital between January 2009 and December 2015. Patients were divided into three tertiles based on Hgb-Var, as reflected by SD Hgbmean, SD Hgbrange, and Hgbdeflection during a 12-month evaluation period after hemodialysis initiation. Left ventricular ejection fraction (EF) and left ventricular mass index (LVMI) were evaluated by echocardiography. Information on cardiovascular deaths occurred by December 2017 was collected. Multivariate Cox regression models were constructed to evaluate the association between Hgb-Var and cardiovascular mortality.

Results

A total of 75 deaths and 52 cardiovascular deaths occurred during the 47-month follow-up (range 29.5–70). Under multivariate regression, the subgroup with the highest Hgb-Var had a higher risk of cardiovascular mortality after adjusting for relevant factors (HR vs. lowest SD Hgbmean: 9.15, 95% CI 2.82, 29.693, P < 0.0001; HR vs. lowest SD Hgbrange: 3.81, 95% CI 1.40, 10.38, P = 0.005). Per 1 SD of Hgbmean and Hgbrange elevations were both related to a 10% increase in the cardiovascular mortality risk. Baseline EF% and LVMI did not differ across the Hgb-Var subgroups. EF% upon the last patient visit to the clinic was lower in the subgroup with the highest SD Hgbmean (P = 0.02).

Conclusions

High Hgb-Var is an independent risk factor for cardiovascular mortality in hemodialysis patients and might influence the cardiac function.

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (Grant No. 81500507) and Young Investigator Scholarship of Xin Hua Hospital (Grant No. 2015001).

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Author notes

  1. Fu-Jun Lin and Xi Zhang have contributed equally to this work.

Authors and Affiliations

  1. Renal Division, Department of Internal Medicine, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China

    Fu-Jun Lin, Lu-Sheng Huang, Gang Ji, Hai-Dong Huang, Yun Xie, Geng-Ru Jiang & Wei Lu

  2. Clinical Research Unit, Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Xi Zhang & Xin Zhou

Authors
  1. Fu-Jun Lin
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  2. Xi Zhang
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  3. Lu-Sheng Huang
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  4. Gang Ji
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  5. Hai-Dong Huang
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  6. Yun Xie
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  7. Geng-Ru Jiang
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  8. Xin Zhou
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  9. Wei Lu
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Corresponding authors

Correspondence to Xin Zhou or Wei Lu.

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The authors declare no competing financial interests.

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Lin, FJ., Zhang, X., Huang, LS. et al. Impact of hemoglobin variability on cardiovascular mortality in maintenance hemodialysis patients. Int Urol Nephrol 50, 1703–1712 (2018). https://doi.org/10.1007/s11255-018-1919-5

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  • DOI: https://doi.org/10.1007/s11255-018-1919-5

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