Optimal hemoglobin level for anemia treatment in a cohort of hemodialysis patients.
BACKGROUND
Anemia is a major risk factor that contributes to mortality in patients with chronic kidney disease. There is controversy over the optimal hemoglobin (Hb) target in these patients. This study investigated the association between Hb level and mortality in a cohort of hemodialysis (HD) patients in Korea.


METHODS
This study was a multicenter prospective observational study of maintenance HD patients that was performed for 5 years in western Seoul, Korea. Three hundred and sixty-two participants were enrolled. Laboratory values and mortality were accessed every 6 months. Repeated measures of laboratory values in each interval were averaged to obtain one semiannual mean value. The Hb values were divided into six groups: (1) Hb<9 g/dL; (2) 9 g/dL≤Hb<10 g/dL; (3) 10 g/dL≤Hb<11 g/dL; (4) 11 g/dL≤Hb<12 g/dL; (5) 12 g/dL≤Hb<13 g/dL; and (6) Hb≥13 g/dL. We analyzed the odds ratio for all-cause mortality, based on the Hb group, and adjusted for demographics and various laboratory values. Statistics were performed with SAS, version 9.1 software (SAS Institute Inc., Cary, NC, USA).


RESULTS
Mortality odds ratios relative to the reference group (10-11 g/dL) in the fully adjusted model were 3.61 for<9 g/dL; 3.17 for 9-10 g/dL(⁎); 4.65 for 11-12 g/dL(⁎); 5.50 for 12-13 g/dL(⁎); and 2.05 for≥13 g/dL ((⁎) indicates P<0.05).


CONCLUSIONS
In this study, a Hb level of 10-11 g/dL was associated with the lowest mortality among the groups with Hb level<13 g/dL. Larger interventional trials are warranted to determine the optimal Hb target for Korean HD patients.
Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Mi Yeon
MY
Jung
Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
Soon Young
SY
Hwang
Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Yu Ah
YA
Hong
Institute of Kidney Disease Research, Korea University College of Medicine, Seoul, Korea.
Su Young
SY
Oh
Institute of Kidney Disease Research, Korea University College of Medicine, Seoul, Korea.
Jae Hee
JH
Seo
Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Young Mo
YM
Lee
Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Sang Won
SW
Park
Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Jung Sun
JS
Kim
Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Joon Kwang
JK
Wang
Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Jeong Yup
JY
Kim
Division of Nephrology, Department of Internal Medicine, Won Kwang University College of Medicine, Iksan, Korea.
Ji Eun
JE
Lee
Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Gang Jee
GJ
Ko
Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Heui Jung
HJ
Pyo
Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Young Joo
YJ
Kwon
Anemia; Hemodialysis; Hemoglobin; Mortality