Association between haemoglobin level and all-cause mortality in haemodialysis patients: the link with inflammation and malnutrition.

A b s t r a c t: Although anaemia management has improved in haemodialysis (HD) patients in recent years, many of them still have haemoglobin (Hb) levels below the current recommendations. The consequent anaemia could be one of the links between malnutrition and inflammation, and higher mortality in HD patients. The study objective was to determine the relationship between Hb levels and outcome in patients undergoing HD, accounting for inflammation and malnutrition. We retrospectively analysed a total of 236 patients on HD between January 2003 and December 2005, classified by absence or presence of inflammation and malnutrition (defined as serum albumin levels 8mg/l). Serum levels of Hb, ferritin, creatinine, cholesterol, triglycerides, HDL (high-density lipoprotein cholesterol), LDL (low-density lipoprotein cholesterol), albumin and CRP were measured monthly, fibrinogen was measured every third month. Over the period of three years, 73 out of 236 patients (30%) had died, most from cardiovascular diseases (62%). Presence of inflammation and malnutrition (in 44% of patients) was associated with older age (60.69 ± 12.46 vs. 54.52 ± 12.37, p = 0.0002), lower levels of Hb (99.53 ± 14.97 vs. 111.86 ± 10.38 g/l, p = 0.0000), creatinine (835.88 ± 179.84 vs. 1069.98 ± 821.23 µmol/l, p = 0.0047), albumin (36.58 ± 3.41 vs. 40.32 ± 2.82 g/l, p = 0.0000), cholesterol (4.32 ± 1.04 vs. 4.75 ± 1.09 mmol/l, p = 0.0025) and higher levels of fibrinogen (4.94 ± 1.18 vs. 4.29 ± 0.91g/l, p = 0.0000) and CRP (30.42 ± 29.47 vs. 5.24 ± 4.89 mg/l, p =