title: Haemoglobin levels and health-related quality of life in young and elderly patients on specialized predialysis care.
abstract: BACKGROUND
  In predialysis patients, the optimal treatment choices for controlling haemoglobin (Hb) are unknown, because targeting high Hb levels has negative effects--poorer survival--but possible positive effects as well--better health-related quality of life (HRQOL). Moreover, these effects may be different in specific subgroups (e.g. young versus elderly).
  
  
  METHODS
  In the PREPARE-2 follow-up study, incident predialysis patients were included (2004-2011) when referred to 1 of the 25 participating Dutch outpatient clinics. HRQOL was assessed at 6-month intervals with the short form-36 (SF-36) questionnaire [physical/mental summary measure and eight subscales (range 0-100)]. A linear mixed model was used to associate Hb [<11, ≥ 11 to <12 (reference), ≥ 12 to <13 and ≥ 13 g/dL] with HRQOL, stratified by prescription of anaemia medication (erythropoietin-stimulating agent (ESA)/iron) and age (young: <65 years and elderly: ≥ 65 years).
  
  
  RESULTS
  Only elderly patients (n = 214) not prescribed ESA/iron and with a high Hb (≥ 13 versus ≥ 11 to <12 g/dL) had a statistically significant (P < 0.05) and/or clinically relevant (>3-5 points) higher physical [11.9, 95% confidence interval (CI) 1.7, 22.2] and mental (6.4, 95% CI -1.7, 14.6) summary score. High Hb was not associated with a higher HRQOL in elderly patients who were prescribed ESA/iron. However, only young patients (n = 157) prescribed ESA/iron and with a high Hb (≥ 13 versus ≥ 11 to <12 g/dL) had a higher physical (8.9, 95% CI 2.1, 15.8) and mental (6.2, 95% CI -0.4, 12.8) summary score.
  
  
  CONCLUSIONS
  The association of Hb levels with HRQOL differs by age and use of ESA/iron medication on predialysis care. Therefore, medical care should aim for shared decision-making regarding the appropriate Hb target leading to more individualized care.
authors: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.
authors: Moniek C M
authors: MC
authors: de Goeij
authors: Department of Medical Psychology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.
authors: Yvette
authors: Y
authors: Meuleman
authors: Department of Medical Psychology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.
authors: Sandra
authors: S
authors: van Dijk
authors: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands Landsteiner Institute, Medical Center Haaglanden, The Hague, Zuid-Holland, The Netherlands.
authors: Diana C
authors: DC
authors: Grootendorst
authors: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.
authors: Friedo W
authors: FW
authors: Dekker
authors: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.
authors: Nynke
authors: N
authors: Halbesma
mesh_terms: D000367:Age Factors; D000368:Aged; D000740:Anemia / Q000378:metabolism / Q000517:prevention & control; D015415:Biomarkers / Q000097:blood*; D004921:Erythropoietin / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000523:psychology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D006435:Renal Dialysis; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; C554270:EPO protein, human; D006454:Hemoglobins; D004921:Erythropoietin
keywords: anaemia medication; elderly; haemoglobin; health-related quality of life; predialysis care