Severe anemia compromises hemodialysis vascular access, survival

  • Locham S & al.
  • Ann Vasc Surg
  • 23 ago. 2019

  • de Yael Waknine
  • Clinical Essentials
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Takeaway

  • Severe anemia is associated with reduced durability of hemodialysis (HD) vascular access and poorer survival among patients with stage IV-V chronic kidney disease.

Why this matters

  • According to the authors, this is the largest study to date reporting outcomes stratified by anemia severity.
  • Presurgical correction of anemia may help reduce mortality and improve durability of vascular access.

Study design

  • Study of 28,000 patients undergoing surgery for placement of arteriovenous fistula (AVF) or graft (AVG) from the Vascular Quality Initiative-HD database.
  • Preoperative anemia was classified by WHO standards as no/mild (41.8%), moderate (49.2%), or severe (9.1%). 
  • Mean follow-up of primary patency was 9.60±7.86 months.
  • Funding: None.    

Key results

  • Patients with severe, moderate, and no/mild anemia faced similar (all P>.05) rates of:
    • In-hospital bleeding (2.2% vs 2.2% and 2.1%);
    • Swelling (0.7% vs 0.5% and 0.4%); and
    • Wound infection (0.1% vs 0.3% and 0.4%).
  • The 30-day mortality rate was significantly higher with severe vs moderate and no/mild anemia (2.1% vs 1.1% and 1.1%; P<.001>
  • In multivariate analysis, severe vs no/mild anemia was tied to:
    • 90% increased risk for 30-day mortality (OR=1.90; P=.006).
    • 17% increase in primary patency loss at 1 year (aHR=1.17; P=.03).

Limitations

  • Retrospective, observational design cannot prove causation.
  • Few patients with severe anemia.