Severe anemia in patients with stage 4 to 5 chronic kidney disease is associated with less durable vascular access for hemodialysis (HD) and worse survival, Mahmoud Malas, MD, MHS, of the University of California, San Diego, and colleagues reported in the Annals of Vascular Surgery.

Of 28,000 patients who underwent surgery for an arteriovenous fistula or graft identified using the Vascular Quality Initiative-HD database, 42% had normal to mild anemia (hemoglobin levels less than 10 g/dL in female patients and less than 12 g/dL in male patients [M]), 49% had moderate anemia (F: 7-9.9 g/dL; M: 9-11.9 g/dL), and 9% had severe anemia (F: less than 7 g/dL; M: less than 9 g/dL) prior to surgery.

Postoperative outcomes were statistically similar for the mild/normal, moderate, and severe anemia groups with respect to in-hospital bleeding (2.1% vs 2.2% vs 2.2%, respectively), swelling (0.4% vs 0.5% vs 0.7%), and wound infection (0.4% vs 55 0.3% vs 0.1%). But patients with severe anemia were twice as likely to die within 30 days (2.1% vs 1.1% and 1.1%, respectively).

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After adjustment for comorbidities, severe anemia was associated with a significant 90% higher risk for 30-day mortality and a 17% increase in primary patency loss at 1 year compared with normal/mild anemia. The team found no significant increase in risks for the moderate anemia group.

The authors said their study is the largest to date to report the adverse outcomes and durability of vascular access in HD patients with different degrees of anemia.

“Correction of anemia prior to access creation may help in reducing operative mortality and improving access durability in HD patients,” Dr Malas and his colleagues concluded.

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Locham S, Mathlouthi A, Dakour-Aridi H, et al. Association between severe anemia and outcomes of hemodialysis vascular access [published online August 23, 2019]. Ann Vasc Surg. doi:10.1016/j.avsg.2019.06.016