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. 2018 Aug 7;7(15):e009206.
doi: 10.1161/JAHA.118.009206.

Association of Anemia and Iron Parameters With Mortality Among Patients Undergoing Prevalent Hemodialysis in Taiwan: The AIM - HD Study

Ko-Lin Kuo  1   2 , Szu-Chun Hung  1   2 , Wei-Cheng Tseng  3   4 , Ming-Tsun Tsai  3   4 , Jia-Sin Liu  5 , Ming-Huang Lin  6 , Chih-Cheng Hsu  4   6   7   8 , Der-Cherng Tarng  3   4   9 ; Taiwan Society of Nephrology Renal Registry Data System
Affiliations

Association of Anemia and Iron Parameters With Mortality Among Patients Undergoing Prevalent Hemodialysis in Taiwan: The AIM - HD Study

Ko-Lin Kuo et al. J Am Heart Assoc. .

Abstract

Background The Taiwan Health Insurance Bureau has conducted a bundled payment system for hemodialysis reimbursement since 1995. The maximum dose of erythropoiesis-stimulating agents allowed by insurance is capped at 20 000 U of epoetin or 100 μg of darbepoetin alfa per month. Nephrologists have avoided the use of high dosages of erythropoiesis-stimulating agents to achieve a hemoglobin level of 10 to 11 g/dL by iron supplementation. The clinical impact of these policies on patients' outcomes is unknown. The authors aimed to assess the AIM-HD (Association of Anemia, Iron parameters, and Mortality among the prevalent Hemodialysis patients) Study in Taiwan. Methods and Results The AIM-HD study was conducted based on the Taiwan Renal Registry Data System. From 2001 to 2008, the authors enrolled 42 230 patients undergoing hemodialysis who were older than 20 years and had received hemodialysis for more than 12 months. Patient follow-ups occurred until death or December 31, 2008. During a study period of 8 years, 12 653 (30.0%) patients died. After multivariate adjustment, the authors found that a hemoglobin level <10 g/dL was significantly associated with higher risk for all-cause and cardiovascular deaths. Moreover, a serum ferritin level between 300 and 800 ng/mL and transferrin saturation value between 30% and 50% were associated with the lowest all-cause mortality. Conclusions The authors recommend avoiding a low hemoglobin level and maintaining serum ferritin between 300 and 800 ng/mL and transferrin saturation between 30% and 50%, which were associated with lower risks of all-cause mortality among patients undergoing hemodialysis receiving the restricted erythropoiesis-stimulating agent doses but prompt intravenous iron supplementation in Taiwan.

Keywords: anemia; erythropoietin; hemodialysis; hemoglobin; iron.

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Figures

Figure 1
Figure 1
Flowchart of patient selection.
Figure 2
Figure 2
Associations between hemoglobin values and all‐cause (A), cardiovascular (B), ischemic stroke (C), and infection‐related (D) mortality in 42 230 patients undergoing maintenance hemodialysis. HR indicates hazard ratio.
Figure 3
Figure 3
Associations between serum ferritin levels and all‐cause (A), cardiovascular (B), ischemic stroke (C), and infection‐related (D) mortality in 42 230 patients undergoing maintenance hemodialysis. HR indicates hazard ratio.
Figure 4
Figure 4
Associations between transferrin saturation (TSAT) values and all‐cause (A), cardiovascular (B), ischemic stroke (C), and infection‐related (D) mortality in 42 230 patients undergoing maintenance hemodialysis. HR indicates hazard ratio.
Figure 5
Figure 5
Cubic spline and 95% confidence level of all‐cause mortality for hemoglobin (A), serum ferritin (B), and transferrin saturation (TSAT) (C) in 42 230 patients undergoing maintenance hemodialysis.
See this image and copyright information in PMC

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