Association between post-dialysis hemoglobin level and the survival of vascular access

J Vasc Access. 2018 Jan;19(1):69-75. doi: 10.5301/jva.5000798.


Introduction: Although a few dialysis facilities conduct a complete blood cell count for some patients at post-dialysis, including hemoglobin, clinical findings supporting the interpretation of results are scarce. The aim of this study was to investigate the association between post-dialysis hemoglobin level and vascular access failure with clinical data.

Methods: Study design: Case crossover design.

Setting: Japanese dialysis facilities, which routinely take post-dialysis blood samples, including complete blood cell counts at least once a month.

Participants: Hemodialysis patients who experienced vascular access failure in January 2010 until December 2014.

Exposure: Post-dialysis hemoglobin level.

Main outcome: Vascular access failure treated with endovascular treatment or operation.

Statistical analysis: Self-matched odds ratios and 95% confidence intervals were estimated by comparing post-dialysis hemoglobin just before events ("case") with levels at 6 and 12 months before events ("control") using conditional logistic regression, and presented with restricted cubic spline.

Results: Two hundred and thirty hemodialysis patients with vascular access failure were identified. Mean post-dialysis hemoglobin level before the failure was 11.8 g/dL (standard deviation 1.7). The spline curve showed that higher post-dialysis hemoglobin levels above 11.8 g/dL had a greater odds ratio for vascular access failure. Post-dialysis hemoglobin levels and odds ratios (95% confidence interval) for vascular access failure relative to the reference value (Hb 11.8 g/dL) were Hb 12.0 g/dL, 1.1 (1.0-1.1); Hb 14.0 g/dL, 1.4 (1.0-2.0); and Hb 16.0 g/dL, 2.1 (1.1-4.3).

Conclusions: A higher post-dialysis hemoglobin level was associated with vascular access failure. Higher post-dialysis Hb could be a factor that triggers vascular access failure.

Keywords: Hemodialysis; Post-dialysis hemoglobin; Vascular access.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Arteriovenous Shunt, Surgical / adverse effects*
  • Biomarkers / blood
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • Cross-Over Studies
  • Female
  • Graft Occlusion, Vascular / blood
  • Graft Occlusion, Vascular / etiology*
  • Graft Occlusion, Vascular / physiopathology
  • Graft Occlusion, Vascular / therapy
  • Hemoglobins / metabolism*
  • Humans
  • Japan
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / therapy*
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Renal Dialysis* / adverse effects
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Vascular Patency


  • Biomarkers
  • Hemoglobins