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Cut-off values of haemoglobin and clinical outcomes in incident peritoneal dialysis: the PDTAP study.

Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China. Renal Division, Department of Medicine, Second Hospital of Hebei Medical University, Hebei, China. Department of Nephrology, Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China. Renal Division, Department of Medicine, Peking University Shenzhen Hospital, Guangdong, China. Renal Division, Department of Medicine, Third Hospital of Hebei Medical University; Hebei, China. Renal Division, Department of Medicine, People's Hospital of Qinghai Province, Qinghai, China. Renal Division, Department of Medicine, Handan Central Hospital, Hebei, China. Renal Division, Department of Medicine, Peking Haidian Hospital, Beijing, China. Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China. Renal Division, Department of Medicine, Cangzhou Central Hospital, Hebei, China. Renal Division, Department of Medicine, Second Affiliated Hospital of Anhui Medical University, Anhui, China. Renal Division, Department of Medicine, First Affiliated Hospital of Zhengzhou University, Henan, China. Renal Division, Department of Medicine, Beijing Miyun District Hospital, Beijing, China. Renal Division, Department of Medicine, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China. Renal Division, Department of Medicine, First Affiliated Hospital of BaoTou Medical College, Neimenggu, China. Renal Division, Department of Medicine, People's Hospital of Langfang, Hebei, China. Renal Division, Department of Medicine, People's Hospital of Gansu, Gansu, China. Renal Division, Department of Medicine, Peking University People's Hospital, Beijing, China. Renal Division, Department of Medicine, Pingdingshan First People's Hospital, Henan, China. Renal Division, Department of Medicine, First People's Hospital of Xining, Qinghai, China. Renal Division, Department of Medicine, Taiyuan Central Hospital, Shanxi, China. Renal Division, Department of Medicine, Cangzhou People's Hospital, Hebei, China. Renal Division, Department of Medicine, First Hospital of Jilin University, Jilin, China. Renal Division, Department of Medicine, People's Hospital of Chuxiong Yi Autonomous Prefecture, Yunnan, China. Renal Division, Department of Medicine, Second Hospital of Shanxi Medical University, Shanxi, China. Renal Division, Department of Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China. Renal Division, Department of Medicine, Beijing Dongzhimen Hospital, Beijing, China. Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2024;(2):251-263
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Abstract

BACKGROUND To explore the cut-off values of haemoglobin (Hb) on adverse clinical outcomes in incident peritoneal dialysis (PD) patients based on a national-level database. METHODS The observational cohort study was from the Peritoneal Dialysis Telemedicine-assisted Platform (PDTAP) dataset. The primary outcomes were all-cause mortality, major adverse cardiovascular events (MACE) and modified MACE (MACE+). The secondary outcomes were the occurrences of hospitalization, first-episode peritonitis and permanent transfer to haemodialysis (HD). RESULTS A total of 2591 PD patients were enrolled between June 2016 and April 2019 and followed up until December 2020. Baseline and time-averaged Hb <100 g/l were associated with all-cause mortality, MACE, MACE+ and hospitalizations. After multivariable adjustments, only time-averaged Hb <100 g/l significantly predicted a higher risk for all-cause mortality {hazard ratio [HR] 1.83 [95% confidence interval (CI) 1.19-281], P = .006}, MACE [HR 1.99 (95% CI 1.16-3.40), P = .012] and MACE+ [HR 1.77 (95% CI 1.15-2.73), P = .010] in the total cohort. No associations between Hb and hospitalizations, transfer to HD and first-episode peritonitis were observed. Among patients with Hb ≥100 g/l at baseline, younger age, female, use of iron supplementation, lower values of serum albumin and renal Kt/V independently predicted the incidence of Hb <100 g/l during the follow-up. CONCLUSION This study provided real-world evidence on the cut-off value of Hb for predicting poorer outcomes through a nation-level prospective PD cohort.

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Publication Type : Observational Study

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