In Copenhagen this year there were many talks and poster presentations relevant to the issue of iron deficiency and anaemia management in CKD patients. However, the COMPACT RENAL team feels that one presentation, in particular, was of note.
Haemoglobin levels at onset of dialysis and their relationship with first year survival
An international team led by Angelo Karaboyas, USA hypothesised that the large number of patients who begin dialysis with below target haemoglobin (Hb) levels may experience increased mortality rates in the first year following dialysis onset. [SP340] They also suggest that this may be associated with the intense treatment these patients receive to bring haemoglobin to target.
To test their hypothesis, the team extracted data from the Dialysis Outcomes and Practice Patterns (DOPPS) database. The study included incident haemodialysis patients with a haemoglobin ≥10 g/dL at 4 months, who also had a haemoglobin level recorded within the first month of dialysis.
From their sample of 4,461 patients in 21 countries, 53% had haemoglobin <10 g/dL when starting dialysis. Patients with the lowest Hb levels received the greatest doses of ESA during the first 3 month. Mean IV iron doses, however, were not as varied.
The study results suggested that that the effective management of anaemia before initiation of dialysis may improve survival during the first year. Haemoglobin levels at the start of dialysis (month 1) were inversely associated with mortality in months 5-12 (adjusted HR for 1 g/dL higher haemoglobin = 0.89; 95% CI: 0.82-0.96). In addition, when results were adjusted for high ESA and IV iron doses, the impact on mortality was minimal.
While the study may be confounded by variability in the overall quality of treatment pre-dialysis, the results suggest that effective anaemia management in pre-dialysis CKD may result in a survival benefit in patients and should be an important component of clinical care.