Dataset Information

Mean Corpuscular Volume and Mortality in Incident Hemodialysis Patients.

ABSTRACT: BACKGROUND/AIMS:Anemia is common in patients with advanced chronic kidney disease (CKD). A proportion of patients present with macrocytic anemia, manifested by elevated mean corpuscular volume (MCV), which has been associated with worse outcomes in CKD patients. However, it is unknown whether elevated MCV is associated with higher mortality risk in incident hemodialysis (HD) patients. METHODS:This retrospective observational cohort study examined all-cause, cardiovascular, and infectious mortality associations with both baseline and time-varying MCV in 109,501 incident HD patients using Cox proportional hazards models with 3 levels of hierarchical multivariable adjustment. Odds ratios of high versus low baseline MCV were evaluated using logistic regression. RESULTS:The mean age of patients was 65 ± 15 (standard deviation) years and the cohort was 44% female, 58% diabetic, and 31% African American. Higher MCV was associated with older age, female sex, non-Hispanic White race-ethnicity, alcohol consumption, and having a decreased albumin or protein intake. Patients with higher MCV levels (> 98 fL) had a higher all-cause, cardiovascular, and infectious mortality risk in both baseline and time varying models, and across all levels of adjustment. In the fully adjusted models, compared to a reference of MCV 92-< 94 fL, patients with a baseline MCV > 100+ fL had a 28% higher risk of all-cause mortality (hazard ratio [HR] 1.28, 95% CI 1.22-1.34), 27% higher risk of cardiovascular mortality (HR 1.27, 95% CI 1.18-1.36), and 18% higher risk of infectious mortality (HR 1.18, 95% CI 1.02-1.38). Associations of higher MCV with these adverse outcomes persisted across all examined subgroups of clinical characteristics. CONCLUSIONS:Higher MCV was associated with higher all-cause, cardiovascular, and infectious mortality in HD patients. Further investigation is necessary to understand the underlying nature of the observed association.

SUBMITTER: Dratch A

PROVIDER: S-EPMC6465067 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Mean Corpuscular Volume and Mortality in Incident Hemodialysis Patients.

Dratch Alissa A Kleine Carola-Ellen CE Streja Elani E Soohoo Melissa M Park Christina C Hsiung Jui-Ting JT Rhee Connie M CM Obi Yoshitsugu Y Molnar Miklos Z MZ Kovesdy Csaba P CP Kalantar-Zadeh Kamyar K

Nephron 20190109 3

<h4>Background/aims</h4>Anemia is common in patients with advanced chronic kidney disease (CKD). A proportion of patients present with macrocytic anemia, manifested by elevated mean corpuscular volume (MCV), which has been associated with worse outcomes in CKD patients. However, it is unknown whether elevated MCV is associated with higher mortality risk in incident hemodialysis (HD) patients.<h4>Methods</h4>This retrospective observational cohort study examined all-cause, cardiovascular, and inf ...[more]

PMID: 30625478

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Project description:In the general population, low serum magnesium levels are associated with poor outcomes and death. While limited data suggest that low baseline magnesium levels may be associated with higher mortality in hemodialysis (HD) patients, the impact of changes in magnesium levels over time is unknown.We examined the association of time-varying serum magnesium levels with all-cause mortality using multivariable time-varying survival models adjusted for clinical characteristics and other time-varying laboratory measures.9,359 maintenance HD patients treated in a large dialysis organization between 2007 and 2011.Time-varying serum magnesium levels across 5 magnesium increments (<1.8, 1.8-<2.0, 2.0-<2.2, 2.2-<2.4, and ?2.4mg/dL).All-cause mortality.2,636 individuals died over 5 years. Time-varying serum magnesium levels < 2.0mg/dL were associated with higher mortality after adjustment for demographics and comorbid conditions, including hypertension, diabetes, and malignancies (reference: magnesium, 2.2-<2.4mg/dL): adjusted HRs for serum magnesium level < 1.8 and 1.8 to <2.0mg/dL were 1.39 (95% CI, 1.23-1.58; P<0.001) and 1.20 (95% CI, 1.06-1.36; P=0.004), respectively. Some associations were attenuated to the null after incremental adjustment for laboratory test results, particularly serum albumin. However, among patients with serum albumin measurements, low albumin level (<3.5g/dL) and magnesium level < 2.0mg/dL were associated with an additional death risk (adjusted HR, 1.17; 95% CI, 1.05-1.31; P=0.004), whereas patients with high serum albumin levels (?3.5g/dL) exhibited low death risk (adjusted HRs of 0.53 and 0.53 [P?0.001] for magnesium < 2.0 and ?2.0mg/dL, respectively; reference: albumin < 3.5g/dL and magnesium ? 2.0mg/dL).Causality cannot be determined, and residual confounding cannot be excluded given the observational study design.Lower serum magnesium levels are associated with higher mortality in HD patients, including those with hypoalbuminemia. Interventional studies are warranted to examine whether correction of hypomagnesemia ameliorates adverse outcomes in this population.

Project description:Preoperative anemia and high red cell distribution width (RDW) are associated with higher perioperative mortality. Conditions with high RDW levels can be categorized by mean corpuscular volume (MCV). The relationship between RDW, anemia and MCV may explain causality between high RDW levels and outcomes. We aim to establish the prevalence of preoperative anemia and distribution of RDW and MCV among pre-surgical patients in Singapore. In addition, we aim to investigate the association between preoperative anemia, RDW and MCV levels with one-year mortality after surgery.Retrospective review of 97,443 patients aged > = 18 years who underwent cardiac and non-cardiac surgeries under anesthesia between January 2012 and October 2016. Patient demographics, comorbidities, priority of surgery, surgical risk classification, perioperative transfusion, preoperative hemoglobin, RDW, MCV were collected. WHO anemia classification was used. High RDW was defined as >15.7%. Multivariate regression analyses were done to identify independent risk factors for mild or moderate/severe anemia and high RDW (>15.7). Multivariate cox regression analysis was done to determine the effect of preoperative anemia, abnormal RDW and MCV values on 1-year mortality.Our cohort comprised of 94.7% non-cardiac and 5.3% cardiac surgeries. 88.7% of patients achieved 1 year follow-up. Anemia prevalence was 27.8%-mild anemia 15.3%, moderate anemia 12.0% and severe anemia 0.5%. One-year mortality was 3.5%. Anemia increased with age in males, while in females, anemia was more prevalent between 18-49 years and > = 70 years. Most anemics were normocytic. Normocytosis and macrocytosis increased with age, while microcytosis decreased with age. Older age, male gender, higher ASA-PS score, anemia (mild- aHR 1.98; moderate/severe aHR 2.86), macrocytosis (aHR 1.47), high RDW (aHR 2.34), moderate-high risk surgery and emergency surgery were associated with higher hazard ratios of one-year mortality.Preoperative anemia is common. Anemia, macrocytosis and high RDW increases one year mortality.

Dataset Information

Mean Corpuscular Volume and Mortality in Incident Hemodialysis Patients.

Publications

Mean Corpuscular Volume and Mortality in Incident Hemodialysis Patients.

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