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  • Title: Association between post-dialysis hemoglobin level and the survival of vascular access.
    Author: Nishiwaki H, Hasegawa T, Ikenoue T, Tominaga N, Yazawa M, Kawarazaki H, Shibagaki Y, Yamamoto Y, Fukuma S, Yamazaki S, Fukuhara S.
    Journal: J Vasc Access; 2018 Jan; 19(1):69-75. PubMed ID: 29076517.
    Abstract:
    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.
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