HDCN Abstract:  ASN Annual Meeting -- San Francisco  

Streja E, Kopple JD, Kovesdy CP, et al.

Is High Platelet Count Responsible for Increased Death Risk in Dialysis Patients with Hemoglobin >13 g/dL?

ASN Annual Meeting -- San Francisco
J Am Soc Nephrol (Nov) 18:696A 2007

Background: Recent studies have indicated a trend towards increased death risk with targeted hemoglobin (Hb) >13 g/dL in CKD patients (pts)receiving erythropoiesis stimulating agents (ESA) including maintenance hemodialysis (MHD) pts. The mechanism of this effect is unclear but appears to relate to an excess of cardiovascular deaths. We hypothesized that this adverse effect of higher hemoglobin may be related to an associated high platelet count.

Methods: We examined mortality predictability of the baseline Hb in different strata of platelet counts in a 3-yr (7/01- 6/04) cohort of 34,228 DaVita MHD patients with Hb>10 g/dL.

Results: After dividing Hb range into 4 groups (10-11, 11-12, 12-13, and 13 g/dL), survival models were examined in two separate platelet count strata (<300k vs.300k) adjusting for available potential confounders including case- mix (age, gender, race/ethnicity, diabetes, other comorbidities, vintage, insurance, marriage, SMR), Kt/V, dialysis catheter, ESA dose, and laboratory surrogates of nutrition and inflammation (nPNA, serum albumin, creatinine, phosphorus, bicarbonate, TIBC, ferritin, and WBC). Compared to Hb 12-13 (which showed the greatest survival), Hb13 was not associated with increased death risk in the low platelet category (hazard ratio [HR]: 1.03, 95%CI: 0.98-1.09, p=0.23), whereas in the high platelet category it was associated with 21% increased death risk (HR: 1.21, 95% CI: 1.02-1.43, p=0.026):



Conclusion: Compared to Hb in 12-13 g/dL range, Hb13 g/dL is associated with 21% increased death risk only in the presence of high platelet count. Additional studies need to verify these findings.

© Copyright 2007-2008, American Society of Nephrology. Reproduced with permission.
Until September of 2008, all ASN abstracts from the 2007 Annual Meeting are available at this link.

Disclaimer: Abstracts often have errors, both typographical and otherwise. This posting is an electronic translation of submitted abstracts which has not been verified against the original submitted abstract nor with the authors for accuracy. As a result, there may be errors, especially with regard to drug doses, but not limited to these. Abstracts undergo only limited review, and data often are changed as a result of the peer review process, so their reliability is less than manuscripts published in peer-reviewed journals. In using these summaries, you are agreeing that you are aware of these limitations.

The materials are provided on an as-is basis without any warranty of any kind, either express or implied. In addition to errors, the information presented may be incomplete or outdated. The information contained is not intended nor recommended as a substitute for professional medical advice. You are advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each device to be used or drug to be administered to verify the dosage, the method and duration of administration, or contraindications. It is the responsibility of the treating physician or other health care professional, relying on independent experience and knowledge of the patient, to determine drug, disease, and the best treatment for the patient.

To the fullest extent permitted by law, HDCN, ASN and their affiliates and suppliers disclaim all warranties, express or implied, including, but not limited to, any warranty of merchantability, non- infringement or fitness for a particular purpose.

In no event shall HDCN, ASN, or their affiliates or suppliers be liable for any damages whatsoever (including, but not limited to, direct, indirect, incidental, consequential, punitive or exemplary damages, or any damages for loss of profits, use, data, goodwill or other intangibles) arising from or in any way relating to these terms, the materials, or any information, goods or services obtained from or referred to in the materials, whether based on warranty, contract, tort (including, but not limited to, negligence), or any other legal theory, and whether or not any or all of the limited entities is advised of the possibility of such damages.