Higher Hemoglobin Found Beneficial

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SAN DIEGO—Higher hemoglobin levels reduce the risk of death and dialysis initiation among patients with CKD, data suggest.

A team led by Derek Larson, MD, of the NorthShore University HealthSystem's Evanston Hospital in Evanston, Ill., studied 208 patients with CKD and anemia, hypothesizing that higher epoetin (EPO) doses would be associated with an increased risk of death or dialysis initiation. Subjects had 36 months of follow-up. The investigators compared average quarterly EPO doses and hemoglobin levels in those who died or started dialysis (52 patients) and those who did not (156 patients).

The researchers observed no significant difference in average quarterly EPO dosage and baseline hemoglobin levels between the two groups. They also found no increased risk of death or dialysis initiation between patients who received EPO doses greater or less than 25,000 units per week. In both groups, hemoglobin level was negatively correlated with EPO dose.

A higher hemoglobin level was associated with a significant 26% reduced risk of death or dialysis initiation, according to findings presented here at the American Society of Nephrology's Renal Week conference.

Dr. Larson noted that the findings challenge those of the Correction of Hemoglobin and Outcomes in Renal Insufficiency (CHOIR) study. In that randomized trial, 1,432 patients with CKD and anemia were randomized to one of two hemoglobin targets (11.3 or 13.5 g/dL) as part of their anemia management.

The study found an increased risk of a composite end point of death, heart failure hospitalization, stroke, and myocardial infarction in the higher-hemoglobin target group.

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