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

Nephrology Dialysis Transplantation, 05/11/2012

Among Correction of Hemoglobin and Outcomes in Renal Disease participants, higher hemoglobin targets, increases in erythropoiesis–stimulating agent dose and in hemoglobin were associated both with increases in diastolic BP (DBP) and with higher event rates; however, increasing DBP was not associated with adverse 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].

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