Study On The Relationship Between The Dynamic Change Of Hemoglobin And Prognosis In Patients With Maintenance Hemodialysis

Objective: To explore the relationship between the dynamic changes of hemoglobin(Hb)and its prognosis in maintenance hemodialysis patients,and to explore a better method for assessing Hb variability.Materials and Methods: Patients who underwent initial hemodialysis at Dalian Central Hospital for 3 months from January 1,2010 to December 31,2016,were eligible for enrollment.Collect basic information,baseline data and comorbidities of patients,follow up every 3 months,and record laboratory measurements of patients.All-cause death during follow-up was defined as the endpoint event.The time interval between the start of hemodialysis treatment and death was survival time,and patients who were alive,lost to follow-up,and kidney transplantation at the end of follow-up were defined as censored values.Data imputation was used to fill in patients with missing values of less than 10% during follow-up to ensure the integrity of follow-up data.Numeric variables were expressed as mean ± standard deviation(SD),and data from normal distributions were compared using independent sample T tests.Non-normally distributed data were compared using the Mann-Whitney U test.Categorical variables are expressed as percentages and compared by a square test.The coefficient of variation(CV = SD / mean)is used to express the dynamic change of Hb.Use R3.5.1 software to build joint model,analyze the dynamic change rule of Hb,and explore the relationship between Hb dynamic change and baseline information and prognosis.According to the CV level(CV > 0.09,CV ≤ 0.09)and the average Hb level(Hb ≤ 90 g / L,90 <average Hb ≤ 110 g / L,average Hb > 110 g / L),the patients were divided into six groups.Kaplan-Meier survival curve was used to verify the relationship between the dynamic change pattern of Hb level and all-cause death and cardiovascular andcerebrovascular death,so as to further determine the best Hb range and variation degree of patients’ prognosis.P < 0.05 means the difference is statistically significant.Results:1.There were 660 patients finally included in the analysis,including 392 males,accounting for 59.3%,and 268 females,accounting for 40.6%.The average starting age of dialysis was 56.4 ± 17.2 years,and the median follow-up time was 24.0 months.The longest follow-up time was 7 years,and the follow-up times were 28 times,with a total of 6,424 follow-ups.2.The patients were divided into two groups according to whether the endpoint event occurred:(1)173 patients with all-cause deaths,accounting for26.2%,of which 116 patients had cardio-cerebral vascular deaths,accounting for 17.6%;(2)no all-causes occurred 487 patients died,accounting for 73.8%.Divided into 6groups according to the average Hb and CV:(1)average Hb≤90g / L,CV> 0.09,61cases;(2)average Hb≤90g / L,CV≤0.09,30 cases;(3)90 <Average Hb≤110g / L,CV>0.09,200 cases;(4)90 <Average Hb≤110g / L,CV≤0.09,155 cases;(5)Average Hb>110g / L,CV> 0.09,89 cases(6)The average Hb> 110 g / L,CV≤0.09,125 cases.3.It can be seen from the joint model that the dynamic change of Hb is significantly related to the prognosis of patients with maintenance hemodialysis.With the change of time,the risk of all-cause death increases by 5% and the risk of cardiovascular and cerebrovascular death increases by 3% for each unit of Hb longitudinal reduction.The correlation coefficient α is statistically significant(P < 0.05).4.Kaplan-meier survival analysis based on CV level and average Hb level showed that:(1)patients with high Hb and low CV(average Hb> 110 g / L,CV ≤ 0.09)had the highest survival rate,and patients with low Hb and low CV(average Hb≤90g / L,CV≤0.09)had the lowest survival rate,the difference was statistically significant(χ2 = 42.113,P <0.001);(2)In cardio-cerebrovascular death,patients in the middle Hb low variability group(90 < The average Hb≤110g / L,CV≤0.09)had the highest survival rate,and the low Hb and CV group had the lowest survival rate(average Hb≤90g / L,CV≤0.09)(P <0.05).(3)Patients with high Hb mean values have significantly higher survival rates in all-cause deaths than patients with low Hb mean values.The same results were obtained in cardio-cerebrovascular death(P <0.001).Conclusion: The dynamic changes of Hb are closely related to the prognosis of maintenance hemodialysis patients.For every 1g / L of longitudinal decrease of Hb,the risk of all-cause death increases by 5%,and the risk of cardio-cerebrovascular death increases by 3%.Controlling the average Hb of patients to Hb > 110 g / L and CV ≤0.09 helps to reduce the risk of all-cause death.Controlling the average Hb of patients to 90 < Hb ≤ 110 g / L and CV ≤ 0.09 is helpful to reduce the risk of cardiovascular and cerebrovascular death.Therefore,it is very important to control Hb at a high level and keep it stable for improving the clinical prognosis of maintenance hemodialysis patients.