Influence of atherosclerosis on the relationship between anaemia and mortality risk in haemodialysis patients

Nephrol Dial Transplant. 2008 Jul;23(7):2329-36. doi: 10.1093/ndt/gfm929. Epub 2008 Jan 10.


Background: Full, as compared with partial, correction of anaemia did not reduce the mortality risk in patients with chronic kidney disease (CKD), although the underlying mechanisms are unknown. Since CKD is a high-risk population for cardiovascular disease (CVD), we tested a hypothesis that the presence of atherosclerosis affects the relationship between anaemia and mortality risk.

Methods: We performed a single-centre 10-year follow-up study with an observational cohort of 505 haemodialysis patients to analyse the relationship between haematocrit and all-cause mortality. Baseline haematocrit levels did not differ between the 153 patients with CVD and the 352 patients without CVD.

Results: During the follow-up, 268 patients died. Both Kaplan-Meier and univariate Cox analyses showed that higher haematocrit levels were a significant predictor of lower risk of death in the CVD (-) group, whereas haematocrit did not predict death in the CVD (+) group. In multivariate Cox analyses, the inverse relationship between haematocrit and mortality in the CVD (-) group remained significant and independent of 14 covariates including the use of erythropoietin. In contrast, using the same Cox models, the CVD (+) group did not show such a beneficial effect of higher haematocrit. Similar observations were made when the subjects were divided based on carotid artery intima-media thickness instead of the presence of CVD.

Conclusions: These results support the hypothesis that the presence of atherosclerosis alters the relationship between anaemia and mortality risk in haemodialysis patients.

MeSH terms

  • Aged
  • Anemia / physiopathology*
  • Atherosclerosis / physiopathology*
  • Carotid Arteries / diagnostic imaging
  • Chronic Disease
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Hematocrit
  • Humans
  • Kaplan-Meier Estimate
  • Kidney Diseases / mortality*
  • Kidney Diseases / physiopathology
  • Kidney Diseases / therapy*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Prognosis
  • Proportional Hazards Models
  • Renal Dialysis*
  • Risk Factors
  • Treatment Outcome
  • Ultrasonography