Impact of higher hemoglobin targets on blood pressure and clinical outcomes: a secondary analysis of CHOIR.

Journal Article (Journal Article)

BACKGROUND: Targeting a higher hemoglobin in patients with chronic kidney disease leads to adverse cardiovascular outcomes, yet the reasons remain unclear. Herein, we sought to determine whether changes in erythropoiesis-stimulating agent (ESA) dose and in hemoglobin were predictive of changes in blood pressure (BP) and whether these changes were associated with cardiovascular outcomes. METHODS: In this secondary analysis of 1421 Correction of Hemoglobin and Outcomes in Renal Disease (CHOIR) participants, mixed model analyses were used to describe monthly changes in ESA dose and hemoglobin with changes in diastolic BP (DBP) and systolic BP (SBP). Poisson modeling was performed to determine whether changes in hemoglobin and BP were associated with the composite end point of death or cardiovascular outcomes. RESULTS: Monthly average DBP, but not SBP, was higher in participants in the higher hemoglobin arm. Increases in ESA doses and in hemoglobin were significantly associated with linear increases in DBP, but not consistently with increases in SBP. In models adjusted for demographics and comorbid conditions, increases in ESA dose (>0 U) and larger increases in hemoglobin (>1.0 g/dL/month) were associated with poorer outcomes [event rate ratio per 1000 U weekly dose per month increase 1.05, (1.02-1.08), P = 0.002 and event rate ratio 1.70 (1.02-2.85), P = 0.05, respectively]. However, increasing DBP was not associated with adverse outcomes [event rate ratio 1.01 (0.98-1.03), P = 0.7]. CONCLUSION: Among CHOIR participants, higher hemoglobin targets, increases in ESA dose and in hemoglobin were associated both with increases in DBP and with higher event rates; however, increasing DBP was not associated with adverse outcomes.

Full Text

Duke Authors

Cited Authors

  • Inrig, JK; Sapp, S; Barnhart, H; Patel, UD; Reddan, D; Singh, A; Califf, RM; Szczech, L

Published Date

  • September 2012

Published In

Volume / Issue

  • 27 / 9

Start / End Page

  • 3606 - 3614

PubMed ID

  • 22573238

Pubmed Central ID

  • PMC3433928

Electronic International Standard Serial Number (EISSN)

  • 1460-2385

Digital Object Identifier (DOI)

  • 10.1093/ndt/gfs123


  • eng

Conference Location

  • England