title: Red blood cell transfusion, hyperkalemia, and heart failure in advanced chronic kidney disease.
abstract: OBJECTIVE
  In recent years, the use of red blood cell (RBC) transfusion for the treatment of chronic kidney disease (CKD)-related anemia has increased. We used the OptumInsight medical claims database to study the association between receiving a transfusion and hyperkalemia and heart failure events.
  
  
  METHODS
  Persons 18-64 years of age with diagnosed stage 4 or 5 CKD (not requiring dialysis) between 2006 and 2010 were followed until their first hospitalization or emergency room visit with a diagnosis of hyperkalemia or heart failure, termination of insurance coverage, or death. We used a case-only design and conditional logistic regression to estimate rate ratios (RR) and 95% confidence intervals (CIs) describing associations between RBC transfusion and the risks of hyperkalemia or heart failure. We used single (1:1) and variable (1:m) self-control matching intervals, with adjustment for time-varying confounders.
  
  
  RESULTS
  Seven thousand eight hundred twenty-nine individuals met our inclusion criteria; two-thirds were age 50 years or older; 43% were women and 51% had diabetes. Rates of hyperkalemia and heart failure were 7.9/100 person-years (95%CI: 7.3, 8.5) and 16.3/100 person-years (95%CI: 15.5, 17.2), respectively. RBC transfusion was associated with an increased risk of both hyperkalemia (single interval matched RR = 12.0, 95%CI: 1.3, 109; multiple interval matched RR = 6.1, 95%CI: 2.5, 15.1) and heart failure (single interval matched RR = 1.7, 95%CI: 0.3, 9.2; multiple interval matched RR = 3.8, 95%CI: 1.4, 10.3).
  
  
  CONCLUSIONS
  In patients with advanced CKD, RBC transfusion appears to be associated with an elevated risk of hyperkalemia and heart failure; further investigation into these risks is warranted.
authors.affiliation: Ascentiant International, Carlsbad, CA, USA.
authors.forename: Karminder
authors.initials: K
authors.lastname: Gill
authors.affiliation: Department of Medicine, University of Maryland, Baltimore, MD, USA.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Fink
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Gilbertson
authors.affiliation: Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Keri L
authors.initials: KL
authors.lastname: Monda
authors.affiliation: Department of Epidemiology, University of Alabama, Birmingham, Birmingham AB, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Lafayette
authors.affiliation: Clinical Development, Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Petersen
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.affiliation: Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Bradbury
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016208:Databases, Factual; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D006947:Hyperkalemia / Q000150:complications / Q000453:epidemiology*; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: anemia; chronic kidney disease; heart failure; hyperkalemia; pharmacoepidemiology; red blood cell transfusion