Takeaway
- Severe anaemia is associated with reduced durability of haemodialysis (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 anaemia severity.
- Presurgical correction of anaemia 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 anaemia 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 anaemia 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 anaemia (2.1% vs 1.1% and 1.1%; P<.001).
- In multivariate analysis, severe vs no/mild anaemia 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 anaemia.
References
References
