Anemia, hospitalization, and mortality in patients receiving peritoneal dialysis in the United States.
BACKGROUND
The view that hemoglobin levels in peritoneal dialysis patients should be maintained at 11 to 12 g/dL is based largely on the results of studies in hemodialysis patients.


METHODS
We studied 13,974 erythropoietin-treated Medicare patients who initiated peritoneal dialysis between 1991 and 1998. Mean hemoglobin levels for the first 6 months of the study and, subsequently, time to first hospitalization and death during a 2-year follow-up were determined.


RESULTS
The percentages of patients with hemoglobin levels of <10, 10 to 10.9, 11 to 11.9, and >/=12 g/dL were 24.6%, 40.6%, 27.6%, and 7.2%, respectively. First-hospitalization and death rates, respectively, were 109.5 and 21.6 per 100 patient-years in nondiabetic patients, and 152.9 and 31.5 in diabetic patients. In nondiabetic patients, adjusted hospitalization hazard ratios for hemoglobin levels of <10, 10 to 10.9, 11 to 11.9 (reference category), and >/=12 g/dL were 1.29 (P < 0.0001), 1.15 (P < 0.0001), 1, and 0.98 (NS), respectively. The corresponding adjusted mortality hazard ratios were 1.43 (P < 0.0001), 1.13 (P < 0.05), 1, and 1.14 (NS). In diabetic patients, hazard ratios of 1.26 (P < 0.0001), 1.07 (NS), 1, and 0.82 (P < 0.01) were observed for hospitalization, and 1.34 (P < 0.0001), 1.18 (P < 0.01), 1, and 0.92 (NS) for mortality.


CONCLUSIONS
In peritoneal dialysis patients, anemia is associated with hospitalization and mortality in a manner supporting current Kidney Dialysis Outcomes Quality Initiative (K/DOQI) hemoglobin targets. In addition, hemoglobin levels of >/=12 g/dL are associated with lower hospitalization rates in diabetic patients.
Li
Shuling
S
Nephrology Analytical Services, Minneapolis Medical Research Foundation, Minneapolis, Minnesota 55404, USA.
Foley
Robert N
RN
Collins
Allan J
AJ
D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D015331:Cohort Studies; D003928:Diabetic Nephropathies / Q000097:blood / Q000150:complications / Q000628:therapy; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000401:mortality*; D011994:Recombinant Proteins; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin