title: Relationship between anaemia management at haemodialysis initiation and patient prognosis.
abstract: OBJECTIVE
  It has been suggested that anaemia management during a transition period to haemodialysis could influence prognosis. In this paper, we have conducted a retrospective investigation on how Hb levels at haemodialysis initiation in patients with chronic kidney disease (CKD) influence the risk of cerebral infarction and cardiovascular events.
  
  
  METHODS
  Seventy-two patients who underwent initial haemodialysis between May 2012 and April 2014 were designated as subjects of the study and the patients were divided into a cohort with Hb levels ≥8 g/dL and a cohort with <8 g/dL at haemodialysis initiation. The occurrence of cardiovascular events was analyzed using the Kaplan-Meier method and Cox proportional hazards model.
  
  
  RESULTS
  The cohort with <8 g/dL Hb levels at haemodialysis initiation demonstrated a tendency toward low dosage of ESA or iron preparation in the pre-haemodialysis (maintenance) phase. Significant incidence of cardiovascular (log rank, P = 0.002) and cerebrovascular (log rank, P = 0.02) events was observed. The results of multivariate analysis of the Cox proportional hazards model indicated that anaemia with <8 g/dL Hb levels at haemodialysis initiation was a significant risk factor for coronary artery (hazard ratio = 12.85, P = 0.003) and cerebrovascular (hazard ratio = 5.11, P = 0.04) diseases post-haemodialysis.
  
  
  CONCLUSIONS
  The results of this investigation indicate the possible involvement of low Hb levels at haemodialysis initiation as a factor in cardio- and cerebrovascular events. There, our results suggested that the administration of adequate dosage of iron preparations and ESA in the pre-haemodialysis period could help prevent cardio- and cerebrovascular events.
authors.affiliation: Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kataoka
authors.affiliation: Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Tsuchiya
authors.affiliation: Department of Nephrology, Jyoban Hospital, Fukushima, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Naganuma
authors.affiliation: Department of Nephrology, Jyoban Hospital, Fukushima, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Okazaki
authors.affiliation: Department of Nephrology, Jyoban Hospital, Fukushima, Japan.
authors.forename: Mizuki
authors.initials: M
authors.lastname: Komatsu
authors.affiliation: Department of Nephrology, Jyoban Hospital, Fukushima, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan.|Department of Nephrology, Jyoban Hospital, Fukushima, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Shiohira
authors.affiliation: Department of Nephrology, Jyoban Hospital, Fukushima, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kawaguchi
authors.affiliation: Department of Medicine IV, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Kosaku
authors.initials: K
authors.lastname: Nitta
mesh_terms: D000368:Aged; D000740:Anemia / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D002544:Cerebral Infarction / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007501:Iron / Q000627:therapeutic use*; D008297:Male; D011379:Prognosis; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D007501:Iron
keywords: cardiovascular disease; chronic kidney disease; haemodialysis initiation; pre-dialysis; renal anaemia