NDT Advance Access originally published online on October 5, 2006
Nephrology Dialysis Transplantation 2007 22(2):500-507; doi:10.1093/ndt/gfl558
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A prospective multicentre study of the role of anaemia as a risk factor in haemodialysis patients: the MAR Study
1Nephrology Service, Fundación Hospital Alcorcón, 2Nephrology Service, Hospital Universitario Gregorio Marañón, Madrid and 3Nephrology Service, Hospital Universitario Reina Sofía, Córdoba, Spain
Correspondence and offprint requests to: José Portolés, MD, PhD, Jefe Servicio de Nefrología, Fundación Hospital Alcorcón, Avda Villaviciosa 1, 28922 Alcorcón (Madrid), Spain. Email: jmportoles{at}fhalcorcon.es
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Abstract |
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Background. Retrospective studies have shown hospitalization and mortality rates during haemodialysis (HD) to be associated with anaemia.
Methods. The prospective, multicentre Morbidity-and-mortality Anaemia Renal (MAR) study was designed to establish the burden of anaemia by controlling for other risk factors. Charlson index was used for comorbid adjustment. Finally, 1428 patients from 119 centres (60% men, aged 64.4 years, time on HD 15.3 months, Charlson comorbidity index 6.5 ± 2.3) completed follow-up. They had hypertension (75.8%), diabetes mellitus (25.9%), heart failure (13.9%) and coronary disease (16.7%). Of the total patients, 94.8% were receiving erythropoietin (111.6 ± 70.6 U/kg/week) and 76.7% i.v. iron, and haemoglobin (Hb) at inclusion was 11.7 ± 1.5 g/dl.
Results. Hospitalization rate was 1.1 admissions/patient/year. Yearly mortality was 12% [35% cardiovascular (CV)]. The relative risk and confidence interval (CI) for hospitalization and death were 0.86 (0.81–0.91) and 0.82 (0.73–0.91), respectively, per 1 g/dl increase in initial Hb after adjustment for comorbidity, vintage, aetiology, access type, albumin and Kt/V. The probability of remaining free from hospitalization (CI) was 0.34 (0.27–0.41) for initial Hb <10 g/dl, 0.47 (0.41–0.53) for Hb 10–11 g/dl, 0.54 (0.49–0.59) for Hb 11–12 g/dl, and 0.63 (0.59–0.67) for Hb >12 g/dl. Same analysis for patient survival was 0.77 (0.71–0.83) for Hb <10 g/dl vs 0.82 (0.77–0.87) for Hb 10–11 vs 0.89 (0.86–0.92) for Hb 11–12 vs 0.92 (0.90–0.94) for Hb > 12 g/dl, P < 0.001. The Cox regression model for hospitalization-free survival included the risk factors initial Hb (relative risk 0.86 per 1 g/dl increase, P < 0.001) Charlson, albumin and prior CV event.
Conclusion. Hb level predicted 1-year-survival and hospitalization. This effect persisted after adjustment for comorbidity and other prognostic factors.
Keywords: anaemia; chronic renal failure; erythropoietin; haemodialysis; hospitalization-free survival; survival analysis
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