Association between Severe Anemia and Outcomes of Hemodialysis Vascular Access.
Aged
Anemia
/ blood
Arteriovenous Shunt, Surgical
/ adverse effects
Biomarkers
/ blood
Blood Vessel Prosthesis Implantation
/ adverse effects
Databases, Factual
Female
Hemoglobins
/ metabolism
Humans
Male
Middle Aged
Prevalence
Renal Dialysis
/ adverse effects
Renal Insufficiency, Chronic
/ blood
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Treatment Outcome
United States
/ epidemiology
Vascular Patency
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
received:
16
04
2019
revised:
31
05
2019
accepted:
04
06
2019
pubmed:
27
8
2019
medline:
17
3
2020
entrez:
27
8
2019
Statut:
ppublish
Résumé
The vast majority of patients undergoing hemodialysis (HD) are anemic. The severity of anemia in these patients may influence the postoperative outcomes and the durability of vascular access. Thus, the purpose of this study is to assess the association between anemia and adverse outcomes in patients undergoing HD access placement (arteriovenous grafts and fistula). Patients with chronic kidney disease stages IV and V recorded in the Vascular Quality Initiative Hemodialysis database between 2011 and 2017 were included. Patients were divided into 3 study groups based on preoperative hemoglobin (Hgb) levels: normal/mild anemia (Hgb: females ≥10 g/dL, males ≥12 g/dL), moderate anemia (Hgb: females: 7-9.9 g/dL, males: 9-11.9 g/dL), and severe anemia (Hgb: females<7 g/dL, males<9 g/dL). Multivariable logistic and Cox regression analyses were implemented to evaluate the association between anemia and 30-day mortality and primary patency (PP) at 1 year. A total of 28,000 patients undergoing HD access surgery were identified (normal/mild [42%], moderate [49%], and severe [9%] anemia). Postoperative bleeding (2.1% vs. 2.2% vs. 2.2%) and 30-day outcomes including swelling (0.4% vs. 0.5% vs. 0.7%) and wound infection (0.4% vs. 0.3% vs. 0.1%) were similar in mild/normal, moderate, and severe anemia groups, respectively (All P > 0.05). However, 30-day mortality was significantly higher in patients with severe anemia compared with normal/mild and moderate anemia (2.1% vs. 1.1% and 1.1%, P < 0.001). After adjusting for potential confounders, severe anemia was associated with 90% higher risk of 30-day mortality (odds ratio [95% confidence interval]: 1.90 [1.20-3.00], P = 0.006) and 17% increase in PP loss at 1 year (adjusted hazard ratio [95% confidence interval]: 1.17 [1.02-1.35], P = 0.01) compared with the normal/mild anemia group. However, no significant difference was seen between normal/mild and moderate anemia. In this large study of patients undergoing HD access placement, severe anemia was associated with 90% increased risk of 30-day mortality and 17% increased risk of loss of PP compared with those with normal/mild anemia. Management of severe anemia before surgery might be indicated to reduce operative mortality and improve the durability of HD access.
Sections du résumé
BACKGROUND
BACKGROUND
The vast majority of patients undergoing hemodialysis (HD) are anemic. The severity of anemia in these patients may influence the postoperative outcomes and the durability of vascular access. Thus, the purpose of this study is to assess the association between anemia and adverse outcomes in patients undergoing HD access placement (arteriovenous grafts and fistula).
METHODS
METHODS
Patients with chronic kidney disease stages IV and V recorded in the Vascular Quality Initiative Hemodialysis database between 2011 and 2017 were included. Patients were divided into 3 study groups based on preoperative hemoglobin (Hgb) levels: normal/mild anemia (Hgb: females ≥10 g/dL, males ≥12 g/dL), moderate anemia (Hgb: females: 7-9.9 g/dL, males: 9-11.9 g/dL), and severe anemia (Hgb: females<7 g/dL, males<9 g/dL). Multivariable logistic and Cox regression analyses were implemented to evaluate the association between anemia and 30-day mortality and primary patency (PP) at 1 year.
RESULTS
RESULTS
A total of 28,000 patients undergoing HD access surgery were identified (normal/mild [42%], moderate [49%], and severe [9%] anemia). Postoperative bleeding (2.1% vs. 2.2% vs. 2.2%) and 30-day outcomes including swelling (0.4% vs. 0.5% vs. 0.7%) and wound infection (0.4% vs. 0.3% vs. 0.1%) were similar in mild/normal, moderate, and severe anemia groups, respectively (All P > 0.05). However, 30-day mortality was significantly higher in patients with severe anemia compared with normal/mild and moderate anemia (2.1% vs. 1.1% and 1.1%, P < 0.001). After adjusting for potential confounders, severe anemia was associated with 90% higher risk of 30-day mortality (odds ratio [95% confidence interval]: 1.90 [1.20-3.00], P = 0.006) and 17% increase in PP loss at 1 year (adjusted hazard ratio [95% confidence interval]: 1.17 [1.02-1.35], P = 0.01) compared with the normal/mild anemia group. However, no significant difference was seen between normal/mild and moderate anemia.
CONCLUSIONS
CONCLUSIONS
In this large study of patients undergoing HD access placement, severe anemia was associated with 90% increased risk of 30-day mortality and 17% increased risk of loss of PP compared with those with normal/mild anemia. Management of severe anemia before surgery might be indicated to reduce operative mortality and improve the durability of HD access.
Identifiants
pubmed: 31449946
pii: S0890-5096(19)30591-6
doi: 10.1016/j.avsg.2019.06.016
pii:
doi:
Substances chimiques
Biomarkers
0
Hemoglobins
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
295-303Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.