RBC Transfusions Among Hemodialysis Patients (1999-2010): Influence of Hemoglobin Concentrations Below 10 g/dL
RBC Transfusions Among Hemodialysis Patients (1999-2010): Influence of Hemoglobin Concentrations Below 10 g/dL
复制标题
DOI：
10.1053/j.ajkd.2013.05.004
复制
发表时间：
2013-11-01
影响因子：
13.2
通讯作者：
Collins, Allan J.
中科院分区：
文献类型：
--
作者：
Gilbertson, David T.;Monda, Keri L.;Collins, Allan J.
背景：在过去的十年中，贫血管理的变化导致血红蛋白浓度下降。我们的目的是研究红细胞（RBC）输注对使用的影响。研究设计：回顾性队列研究。背景和参与者：我们确定了每年（1999-2010）1月1日的医疗保险血液透析患者，并根据每年3个月（4月至6月）的平均血红蛋白水平（< 10或>= 10 g/dL）对他们进行分类。预测指标：血红蛋白随时间变化的模式和基于达到的血红蛋白浓度的临床概况。结果：红细胞输血使用。测量：我们使用负二项模型来检验血红蛋白水平< 10 g/dL对输血使用的影响，并根据病例组合差异进行调整。结果：平均血红蛋白水平< 10 g/dL的患者比例从1999年的10%下降到2005年的4%，但2006年后开始增加，到2010年达到6%。考虑到病例组合差异，输血率保持相对稳定，血红蛋白水平< 10 g/dL的患者约为每100人月7.9次，血红蛋白水平< 10 g/dL的患者为每100人月2次。即使在调整后，平均血红蛋白水平>= 10 g/dL的患者更有可能接受输血（风险比，2.2;95% CI, 2.1-2.2）；如果血红蛋白水平持续< 10 g/dL 6个月，风险比翻倍（4.4;95% CI, 3.7-5.2）。局限性：对医疗保险作为主要支付者的患者的普遍性有限；不能排除虚弱和慢性炎症等因素造成的残留混淆；根据平均3次门诊血红蛋白检测结果对患者进行分类可能会导致一些错误分类。结论：血红蛋白浓度>= 10 g/dL时输血风险显著增加；风险似乎与其他临床因素无关。如果贫血管理模式转向低血红蛋白浓度，透析患者的红细胞输血使用可能会增加。(C) 2013年由国家肾脏基金会，Inc。
Background: Changes in anemia management over the past decade have produced downward shifts in hemoglobin concentrations. We aimed to examine the effect on use of red blood cell (RBC) transfusions.Study Design: Retrospective cohort study.Setting & Participants: We identified point prevalent Medicare hemodialysis patients as of January 1 of each year (1999-2010) and categorized them based on 3-month (April to June) mean hemoglobin levels (< 10 or >= 10 g/dL) in each year.Predictors: Hemoglobin patterns over time and clinical profiles based on achieved hemoglobin concentrations.Outcomes: RBC transfusion use. Measurements: We used negative binomial modeling to examine the effect of hemoglobin level < 10 g/dL on transfusion use, adjusting for case-mix differences.Results: Proportions of patients with mean hemoglobin levels < 10 g/dL decreased from 10% (1999) to similar to 4% (2005), but began increasing after 2006 and reached 6% by 2010. Accounting for case-mix differences, transfusion rates remained relatively constant at approximately 7.9 per 100 person-months for patients with hemoglobin levels < 10 g/dL and 2 per 100 person-months for patients with hemoglobin levels < 10 g/dL. Patients with average hemoglobin levels >= 10 g/dL were more likely to receive transfusions (risk ratio, 2.2; 95% CI, 2.1-2.2) even after adjustment; the risk ratio doubled if hemoglobin levels remained < 10 g/dL for 6 months (4.4; 95% CI, 3.7-5.2). Limitations: Limited in generalizability to patients with Medicare as primary payer; residual confounding from factors such as frailty and chronic inflammation cannot be excluded; categorizing patients based on an average of 3 outpatient hemoglobin measurements may introduce some misclassification.Conclusions: Risk of transfusion increases substantially with hemoglobin concentrations >= 10 g/dL; risk appears to be independent of other clinical factors. If anemia management patterns shift toward lower hemoglobin concentrations, RBC transfusion use likely will increase in dialysis patients. (C) 2013 by the National Kidney Foundation, Inc.