Similar Outcomes for Two Anemia Treatment Strategies among Elderly Hemodialysis Patients with Diabetes

Abstract

Background/Aims—To compare mortality and cardiovascular risk in elderly dialysis patients with diabetes under two clinical strategies of anemia correction: maintaining hematocrit (Hct) between 34.5 and < 39.0% (high Hct strategy), and between 30.0 and <34.5% (low Hct strategy) using intravenous alpha epoetin. Methods—Observational data were used to emulate a randomized trial in which diabetic patients who initiated hemodialysis in 2006–2008 were assigned to each anemia correction strategy. Inverse-probability weighting was used to adjust for measured time-dependent confounding. Results—Comparing high with low hematocrit strategy, the hazard ratio (95% confidence interval) was 1.07 (0.83, 1.38) for all-cause mortality and 1.00 (0.81, 1.24) for a composite mortality and cardiovascular endpoint. Conclusions—Among a cohort of elderly hemodialysis patients with diabetes, no differences were found between the low and high hematocrit strategies. A lower target hematocrit -per current Food and Drug Administration (FDA) guidelines -appears to be as safe as higher targets among this population.