SAN DIEGO—End-stage renal disease (ESRD) patients starting hemodialysis (HD) enjoy the best survival when their hemoglobin level prior to HD is 9–11 g/dL, investigators confirmed at Kidney Week.

A team led by Melissa Soohoo, MPh, and Kamyar Kalantar-Zadeh, MD, MPH, PhD, nephrology faculty investigators at the University of California Irvine School of Medicine, examined mortality from all causes in 18,555 U.S. Veterans (average age 68) initiating dialysis during 2007-2011. For half of patients, diabetes was the primary cause of ESRD. Roughly a third of veterans were African American and 7% were Hispanic.

Hemoglobin averaged 10.9 g/dL in the 6 months before dialysis. When investigators graphed all-cause mortality during the first 3 months of dialysis, they discovered that prelude hemoglobin showed a U-shaped association. Better survival was observed for hemoglobin 10–11.5 g/dL, whereas higher mortality was seen for both lower and higher hemoglobin levels, below 9 and above 13 g/dL. Patients with the best early dialysis life expectancy had hemoglobin 9–11 g/dL.

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These results confirm the findings of earlier clinical trials and support current therapeutic paradigms for management of pre-ESRD anemia, according to investigators. There may be a sweet spot in the hemoglobin target range during the prelude to ESRD that may achieve the best outcome in dialysis patients, according to the researchers.