Mean Corpuscular Volume and Mortality in Incident Hemodialysis Patients.

Aged Erythrocyte Indices Female Humans Kidney Failure, Chronic / blood Male Middle Aged Renal Dialysis Retrospective Studies
Anemia Incident hemodialysis Mean corpuscular volume Mortality

Journal

Nephron
ISSN: 2235-3186
Titre abrégé: Nephron
Pays: Switzerland
ID NLM: 0331777

Informations de publication

Date de publication:
2019
Historique:
received: 24 05 2018
accepted: 22 11 2018
pubmed: 10 1 2019
medline: 1 1 2020
entrez: 10 1 2019
Statut: ppublish

Résumé

Anemia is common in patients with advanced chronic kidney disease (CKD). A proportion of patients present with macrocytic anemia, manifested by elevated mean corpuscular volume (MCV), which has been associated with worse outcomes in CKD patients. However, it is unknown whether elevated MCV is associated with higher mortality risk in incident hemodialysis (HD) patients. This retrospective observational cohort study examined all-cause, cardiovascular, and infectious mortality associations with both baseline and time-varying MCV in 109,501 incident HD patients using Cox proportional hazards models with 3 levels of hierarchical multivariable adjustment. Odds ratios of high versus low baseline MCV were evaluated using logistic regression. The mean age of patients was 65 ± 15 (standard deviation) years and the cohort was 44% female, 58% diabetic, and 31% African American. Higher MCV was associated with older age, female sex, non-Hispanic White race-ethnicity, alcohol consumption, and having a decreased albumin or protein intake. Patients with higher MCV levels (> 98 fL) had a higher all-cause, cardiovascular, and infectious mortality risk in both baseline and time varying models, and across all levels of adjustment. In the fully adjusted models, compared to a reference of MCV 92-< 94 fL, patients with a baseline MCV > 100+ fL had a 28% higher risk of all-cause mortality (hazard ratio [HR] 1.28, 95% CI 1.22-1.34), 27% higher risk of cardiovascular mortality (HR 1.27, 95% CI 1.18-1.36), and 18% higher risk of infectious mortality (HR 1.18, 95% CI 1.02-1.38). Associations of higher MCV with these adverse outcomes persisted across all examined subgroups of clinical characteristics. Higher MCV was associated with higher all-cause, cardiovascular, and infectious mortality in HD patients. Further investigation is necessary to understand the underlying nature of the observed association.

Sections du résumé

BACKGROUND/AIMS
Anemia is common in patients with advanced chronic kidney disease (CKD). A proportion of patients present with macrocytic anemia, manifested by elevated mean corpuscular volume (MCV), which has been associated with worse outcomes in CKD patients. However, it is unknown whether elevated MCV is associated with higher mortality risk in incident hemodialysis (HD) patients.
METHODS
This retrospective observational cohort study examined all-cause, cardiovascular, and infectious mortality associations with both baseline and time-varying MCV in 109,501 incident HD patients using Cox proportional hazards models with 3 levels of hierarchical multivariable adjustment. Odds ratios of high versus low baseline MCV were evaluated using logistic regression.
RESULTS
The mean age of patients was 65 ± 15 (standard deviation) years and the cohort was 44% female, 58% diabetic, and 31% African American. Higher MCV was associated with older age, female sex, non-Hispanic White race-ethnicity, alcohol consumption, and having a decreased albumin or protein intake. Patients with higher MCV levels (> 98 fL) had a higher all-cause, cardiovascular, and infectious mortality risk in both baseline and time varying models, and across all levels of adjustment. In the fully adjusted models, compared to a reference of MCV 92-< 94 fL, patients with a baseline MCV > 100+ fL had a 28% higher risk of all-cause mortality (hazard ratio [HR] 1.28, 95% CI 1.22-1.34), 27% higher risk of cardiovascular mortality (HR 1.27, 95% CI 1.18-1.36), and 18% higher risk of infectious mortality (HR 1.18, 95% CI 1.02-1.38). Associations of higher MCV with these adverse outcomes persisted across all examined subgroups of clinical characteristics.
CONCLUSIONS
Higher MCV was associated with higher all-cause, cardiovascular, and infectious mortality in HD patients. Further investigation is necessary to understand the underlying nature of the observed association.

Identifiants

DOI: 10.1159/000495726 PMID: 30625478 PMC: PMC6465067
pubmed: 30625478
pii: 000495726
doi: 10.1159/000495726
pmc: PMC6465067
mid: NIHMS1005994
doi:

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

188-200

Subventions

Organisme : NIDDK NIH HHS
ID : K24 DK091419
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK078106
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001414
Pays : United States

Informations de copyright

© 2019 S. Karger AG, Basel.

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Auteurs

Alissa Dratch (A)

Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA.
Fielding School of Public Health at UCLA, Los Angeles, California, USA.

Carola-Ellen Kleine (CE)

Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA.
Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, California, USA.

Elani Streja (E)

Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA.
Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, California, USA.

Melissa Soohoo (M)

Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA.

Christina Park (C)

Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA.

Jui-Ting Hsiung (JT)

Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA.

Connie M Rhee (CM)

Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA.

Yoshitsugu Obi (Y)

Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA.

Miklos Z Molnar (MZ)

Division of Transplant Surgery, Methodist University Hospital Transplant Institute, Memphis, Tennessee, USA.
Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.

Csaba P Kovesdy (CP)

Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, Tennessee, USA.

Kamyar Kalantar-Zadeh (K)

Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA, kkz@uci.edu.
Fielding School of Public Health at UCLA, Los Angeles, California, USA, kkz@uci.edu.
Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, California, USA, kkz@uci.edu.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Mean Corpuscular Volume and Mortality in...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiogiques du sang › Index érythrocytaires › Mean Corpuscular Volume and Mortality in...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Mean Corpuscular Volume and Mortality in...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie chronique › Insuffisance rénale chronique › Défaillance rénale chronique › Mean Corpuscular Volume and Mortality in...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Mean Corpuscular Volume and Mortality in...
questionsmedicales.fr › Thérapeutique › Détoxication par sorption › Dialyse rénale › Mean Corpuscular Volume and Mortality in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Mean Corpuscular Volume and Mortality in...