Anemia and survival in Thai hemodialysis patients: evidence from national registry data.
BACKGROUND
Anemia is a major contributor to morbidity and mortality in chronic dialysis patients. The K/DOQI guideline recommends the target hemoglobin of 11-12 g/dl (hematocrit of 33-36%). However the appropriate hematocrit level for Thai hemodialysis patients has been controversial.


OBJECTIVE
To investigate the influence of anemia on mortality in Thai chronic hemodialysis patients who initiated their dialysis from 1999 through 2003.


METHODS
The data from the Thailand Renal Replacement Therapy Registry who has conducted an annual report of chronic dialysis patients throughout Thailand since 1997 was used. Data of twice- and thrice-weekly hemodialysis patients who had recorded hematocrit from 1999 through 2003 were processed and confirmed before final analysis. Records of 3,211 hemodialysis patients from 301 centers were included.


RESULTS
The original kidney diseases were diabetes mellitus (31.5%) and hypertension (20.9%). Most patients received twice-weekly hemodialysis (86.3%). The mean hematocrit was 29.3 +/- 5.5%. Most patients (72.8%) had hematocrits of less than 33%. Kaplan-Meier analysis showed patients with hematocrit of ?33% or more had better survival than patients with hematocrits of less than 33% (p <0.01). Patients with hematocrits of less than 27, 27-29.9, 30-32.9 and 36% or more had mortality risks of 1.90 (95% CI: 1.31-2.76, p <0.01), 2.10 (95% CI: 1.42-3.09, p <0.01), 1.74 (95% CI: 1.18-2.56, p <0.01) and 1.174 (95% CI: 0.73-1.90, p = 0.51) respectively, compared to those with hematocrit of 33-35.9%.


CONCLUSIONS
The best survival can be achieved in Thai patients with hematocrits of at least 33%.
Krairittichai
Udom
U
Thailand Renal Replacement Therapy Registry, Nephrology Society of Thailand.
Supaporn
Thanom
T
Aimpun
Pote
P
Wangsiripaisan
Adisorn
A
Chaiprasert
Amnart
A
Sakulsaengprapha
Amporn
A
Chittinandana
Anutra
A
Thanachartwet
Wipa
W
Palasawatdhi
Valai
V
Srangsomwong
Soysaang
S
D000740:Anemia / Q000209:etiology* / Q000401:mortality*; D005260:Female; D006400:Hematocrit / Q000592:standards; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D013785:Thailand