Haemoglobin trajectories in chronic kidney disease and risk of major adverse cardiovascular events

ABSTRACT Background The trajectories of haemoglobin in patients with chronic kidney disease (CKD) have been poorly described. In such patients, we aimed to identify typical haemoglobin trajectory profiles and estimate their risks of major adverse cardiovascular events (MACE). Methods We used 5-year...

Full description

Saved in:

Bibliographic Details
Published in:	Nephrology, dialysis, transplantation Vol. 39; no. 4; pp. 669 - 682
Main Authors:	Le Gall, Lisa, Harambat, Jérôme, Combe, Christian, Philipps, Viviane, Proust-Lima, Cécile, Dussartre, Maris, Drüeke, Tilman, Choukroun, Gabriel, Fouque, Denis, Frimat, Luc, Jacquelinet, Christian, Laville, Maurice, Liabeuf, Sophie, Pecoits-Filho, Roberto, Massy, Ziad A, Stengel, Bénédicte, Alencar de Pinho, Natalia, Leffondré, Karen, Prezelin-Reydit, Mathilde
Format:	Journal Article
Language:	English
Published:	England Oxford University Press 27-03-2024
Subjects:	Human health and pathology Life Sciences haemoglobin anaemia major adverse cardiovascular events trajectories joint latent linear mixed model Joint latent linear mixed model Ttrajectories Haemoglobin Anaemia Major adverse cardiovascular events
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	ABSTRACT Background The trajectories of haemoglobin in patients with chronic kidney disease (CKD) have been poorly described. In such patients, we aimed to identify typical haemoglobin trajectory profiles and estimate their risks of major adverse cardiovascular events (MACE). Methods We used 5-year longitudinal data from the CKD-REIN cohort patients with moderate to severe CKD enrolled from 40 nationally representative nephrology clinics in France. A joint latent class model was used to estimate, in different classes of haemoglobin trajectory, the competing risks of (i) MACE + defined as the first event among cardiovascular death, non-fatal myocardial infarction, stroke or hospitalization for acute heart failure, (ii) initiation of kidney replacement therapy (KRT) and (iii) non-cardiovascular death. Results During the follow-up, we gathered 33 874 haemoglobin measurements from 3011 subjects (median, 10 per patient). We identified five distinct haemoglobin trajectory profiles. The predominant profile (n = 1885, 62.6%) showed an overall stable trajectory and low risks of events. The four other profiles had nonlinear declining trajectories: early strong decline (n = 257, 8.5%), late strong decline (n = 75, 2.5%), early moderate decline (n = 356, 11.8%) and late moderate decline (n = 438, 14.6%). The four profiles had different risks of MACE, while the risks of KRT and non-cardiovascular death consistently increased from the haemoglobin decline. Conclusion In this study, we observed that two-thirds of patients had a stable haemoglobin trajectory and low risks of adverse events. The other third had a nonlinear trajectory declining at different rates, with increased risks of events. Better attention should be paid to dynamic changes of haemoglobin in CKD. Graphical Abstract Graphical Abstract Video 10.1093/ndt/gfad235 Video Watch the video of this contribution at https://academic.oup.com/ndt/pages/author_videos gfad235Media1 6341590798112
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0931-0509 1460-2385
DOI:	10.1093/ndt/gfad235