A study conducted by U.S. and international researchers suggests variability in hemoglobin levels prior to the onset of renal failure can be linked to mortality later as patients transition to dialysis.

The study by Keiichi Sumida, MD, from the University of Tennessee Health Sciences Centers, and with colleagues from Japan, Hungary and the University of California, Irvine looked at 11,872 veterans from October 2007 to September 2011 who transitioned from chronic kidney disease to end-stage renal disease (ESRD). The researchers looked at patients’ history of hemoglobin variability (Hb var) 6 months prior to starting dialysis and recorded three Hb values during the time period.

“Outcomes included post-transition all-cause, cardiovascular and infection-related mortality,” which was adjusted for a number of variables, the authors noted, including demographics, comorbidities, length of hospitalization, medications, estimated glomerular filtration rate (eGFR), type of vascular access, Hb parameters, and change in Hb and in the number of Hb measure-ments.

Based on the recorded values, results showed “higher prelude Hb-var was associated with use of iron and antiplatelet agents, tunneled dialysis catheter use, higher levels of baseline Hb, change in Hb, eGFR and serum ferritin,” the authors wrote. “After multivariable adjustment, higher prelude Hb-var was associated with higher post-ESRD all-cause and infection-related mortality, but not cardiovascular mortality for the highest [vs. lowest] quartile of Hb-var.”

The high pre-ESRD Hb-var was associated with higher mortality, “particularly from infectious causes rather than cardiovascular causes,” the authors wrote. “Further research is required to clarify the underlying mechanisms and true causal nature of the observed association.” –by Mark E. Neumann

Sumida K, et al. Am J Nephrol. 2017;doi:10.1159/000484356.

Disclosures: The authors had no relevant financial disclosures.