Hemoglobin concentration and the risk of hemorrhagic and ischemic stroke in patients undergoing hemodialysis: the Q-cohort study

Yotsueda, Ryusuke; Tanaka, Shigeru; Taniguchi, Masatomo; Fujisaki, Kiichiro; Torisu, Kumiko; Masutani, Kosuke; Hirakata, Hideki; Kitazono, Takanari; Tsuruya, Kazuhiko

doi:10.1093/ndt/gfx305

Cited by 24 publications

(20 citation statements)

References 34 publications

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“…Compared with previous cross-sectional studies of anemia prevalence in CKD, we observed higher proportions of severe CKD patients experiencing grade 2 or 3 anemia at any given point of time, likely due to the longitudinal nature of our study enabling us to identify incident anemia events. Our results corroborate earlier findings on the association between anemia and clinical outcomes in smaller and selected populations from the United States or Japan [5,[11][12][13].…”

Section: Discussionsupporting

confidence: 92%

“…Other possible causes of anemia include blood loss, iron deficiency, inflammation and accumulation of uremic toxins [4]. Prevalent anemia in CKD has been associated with cognitive impairment, sleep disturbances, CKD progression, cardiovascular disease and higher mortality in mostly older studies and in selected populations [5][6][7][8][9][10][11][12][13], whereas contemporary unselected population-based data on clinical outcomes associated with anemia are scarce. Treatment options for anemia include iron (oral and intravenous), erythropoietin stimulating agents (ESAs) and red blood cell transfusion to restore hemoglobin levels.…”

Section: Introductionmentioning

confidence: 99%

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Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study

et al. 2019

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Background Routine clinical evidence is limited on clinical outcomes associated with anemia in patients with severe chronic kidney disease (CKD). Methods We linked population-based medical databases to identify individuals with severe CKD (eGFR < 30 mL/ min/1.73 m 2) in Northern Denmark from 2000 to 2016, including prevalent patients as of 1 January 2009 or incident patients hereafter into the study. We classified patients as non-anemic (≥ 12/≥ 13 g/dl hemoglobin (Hgb) in women/men), anemia grade 1 (10-12/13 g/dl Hgb in women/men), 2 (8-10 g/dl Hgb), and 3+ (< 8 g/dl Hgb), allowing persons to contribute with patient profiles and risk time in consecutively more severe anemia grade cohorts. Patients were stratified by dialysis status and followed for clinical outcomes. Results We identified 16,972 CKD patients contributing with a total of 28,510 anemia patient profiles, of which 3594 had dialysis dependent (DD) and 24,916 had non-dialysis dependent (NDD) severe CKD. Overall, 14% had no anemia, 35% grade 1 anemia, 44% grade 2 anemia and 17% grade 3+ anemia. Compared to patients with no anemia, adjusted hazard ratios (HRs) for NDD patients with grade 3+ anemia were elevated for incident dialysis (1.91, 95% CI 1.61-2.26), any acute hospitalization (1.74, 95% CI 1.57-1.93), all-cause death (1.82, 95% CI 1.70-1.94), and MACE (1.14, 95% CI 1.02-1.26). Similar HRs were observed among DD patients. Conclusions Among NDD or DD patients with severe CKD, presence and severity of anemia were associated with increased risks of incident dialysis for NDD patients and with acute hospitalizations, death and MACE for all patients.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study

et al. 2019

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“…≥11.2 g/dL), the adjusted hemorrhagic stroke risk was increased 1.2-, 1.6-, and 2.3-fold for patients in Q3 (hemoglobin 10.6-11.1 g/dL), Q2 (9.8-10.5 g/dL), and Q1 (≤9.7 g/dL), respectively. 21 Richard A. Sherman…”

Section: Data From 77 607 Living Donor Transplants To Patients On Diamentioning

confidence: 99%

“…However, low hemoglobin levels did substantially increase the risk of hemorrhagic stroke . Compared to the quartile of patients with the highest hemoglobin levels (Q4; ≥11.2 g/dL), the adjusted hemorrhagic stroke risk was increased 1.2‐, 1.6‐, and 2.3‐fold for patients in Q3 (hemoglobin 10.6‐11.1 g/dL), Q2 (9.8‐10.5 g/dL), and Q1 (≤9.7 g/dL), respectively …”

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confidence: 96%

Briefly Noted

Sherman¹

2018

Seminars in Dialysis

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“…15 The Q-cohort study revealed that a low Hb level was reported to be associated with a high risk of haemorrhagic stroke, but not of ischaemic stroke. 16 Only sparse data were available on the prevalence of anaemia and anaemia monitoring for more than 1000 patients undergoing haemodialysis in Guangdong Province, China. Little is known about the relationship between different Hb levels and cardiocerebral vascular prognosis in the population of this region.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, associated factors and cardiocerebral vascular prognosis of anaemia among patients on chronic haemodialysis in South Guangdong, China

Liang

Yong

et al. 2020

J Int Med Res

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Objective To assess the prevalence, associated factors and cardiocerebral vascular prognosis of anaemia in patients undergoing haemodialysis. Methods This multicentre, retrospective, observational cohort study included patients on maintenance haemodialysis in South Guangdong, China. Anaemia in haemodialysis was defined as haemoglobin (Hb) <90 g/l. A proportion of patients were enrolled in a follow-up of the cardiocerebral vascular prognosis. Results A total of 1161 patients were enrolled and 938 were followed-up for cardiocerebral vascular events. Of 1161 patients, 250 (21.5%) had anaemia and 524 (45.1%) had an Hb level of 100–120 g/l. Adjusted multivariate logistic regression analysis demonstrated that frequency of dialysis ≤ twice weekly, hypoalbuminaemia and use of unfractionated heparin were independent factors associated with anaemia. Kaplan–Meier survival curve analysis for no myocardial infarction was 100%, 100%, 100% and 100% after 3, 6, 9 and 12 months, respectively, in patients with Hb < 90 g/l; compared with 97%, 95%, 93% and 93%, respectively, in patients with Hb ≥ 130 g/l. Adjusted Cox proportional hazards regression demonstrated that Hb ≥ 130 g/l was an independent risk factor for myocardial infarction. Conclusion Anaemia is highly prevalent among patients undergoing haemodialysis in South Guangdong and requires careful management.

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Hemoglobin concentration and the risk of hemorrhagic and ischemic stroke in patients undergoing hemodialysis: the Q-cohort study

Abstract: Our results suggest that low hemoglobin concentrations are associated with a high risk of hemorrhagic stroke, but not of ischemic stroke, in patients undergoing hemodialysis.

Cited by 24 publications

References 34 publications

Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study

Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: a Danish population-based study

Briefly Noted

Prevalence, associated factors and cardiocerebral vascular prognosis of anaemia among patients on chronic haemodialysis in South Guangdong, China

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