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Titolo	Hemoglobin Variability Does Not Predict Mortality in European Hemodialysis Patients
Autore	Kai-Uwe Eckardt,* Joseph Kim, Florian Kronenberg,± Pedro Aljama,§ Stefan D. Anker,_Bernard Canaud,** Bart Molemans, Peter Stenvinkel, Guntram Schernthaner,±± Elizabeth Ireland, Bruno Fouqueray,§§ and Iain C. Macdougall__Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Erlangen, Germany; International Development, Amgen Ltd., Uxbridge, United Kingdom; ±Division of Genetic Epidemiology, Innsbruck Medical University, Innsbruck, Austria; §Nephrology Service, Hospital Universitario Reina Sofı´a, Cordoba, Spain; _Applied Cachexia Research, Department of Cardiology, Charite´ , Campus Virchow-Klinikum, Berlin, Germany; Centre for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy; *Department of Nephrology, Dialysis and Intensive Care, Lapeyronie University Hospital, Montpellier, France; Department of Renal Medicine, Karolinska University Hospital at Huddinge, Stockholm, Sweden; ±±Department of Medicine I, Rudolfstiftung Hospital, Vienna, Austria; §§International Research and Development, Amgen (Europe) GmbH, Zug, Switzerland; and __King?s College Hospital, London, United Kingdom
Referenza	J Am Soc Nephrol 2010; 21: 1765-1775
Contenuto	Patients with CKD exhibit significant within-patient hemoglobin (Hb) level variability, especially with the use of erythropoiesis stimulating agents (ESAs) and iron. Analyses of dialysis cohorts in the United States produced conflicting results regarding the association of Hb variability with patient outcomes. Here, we determined Hb variability in 5037 European hemodialysis (HD) patients treated over 2 years to identify predictors of high variability and to evaluate its association with all-cause and cardiovascular disease (CVD) mortality. We assessed Hb variability with various methods using SD, residual SD, time-in-target (11.0 to 12.5 g/dl), fluctuation across thresholds, and area under the curve (AUC). Hb variability was significantly greater among incident patients than prevalent patients. Compared with previously described cohorts in the United States, residual SD was similar but fluctuations above target were less frequent. Using logistic regression, age, body mass index, CVD history, dialysis vintage, serum albumin, Hb, angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) use, ESA use, dialysis access type, dialysis access change, and hospitalizations were significant predictors of high variability. Multivariable adjusted Cox regression showed that SD, residual SD, time-in-target, and AUC did not predict all-cause or CVD mortality during a median follow-up of 12.4 months (IQR: 7.7 to 17.4). However, patients with consistently low levels of Hb (_11 g/dl) and those who fluctuated between the target range and _11 g/dl had increased risks for death (RR 2.34; 95% CI: 1.24 to 4.41 and RR 1.74; 95% CI: 1.00 to 3.04, respectively). In conclusion, although Hb variability is common in European HD patients, it does not independently predict mortality.
Data	19.11.2010

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