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J Am Soc Nephrol 10:1309-1316, 1999
© 1999 American Society of Nephrology

REGULAR ARTICLES

Hematocrit Levels and Hospitalization Risks in Hemodialysis Patients

HONG XIA*, JIM EBBEN*, JENNIE Z. MA{dagger} and ALLAN J. COLLINS{dagger}

* Nephrology Analytical Services, Minneapolis Medical Research Foundation, Minneapolis, Minnesota.
{dagger} University of Minnesota, Hennepin County Medical Center, Minneapolis, Minnesota.

Correspondence to Dr. Allan J. Collins, Nephrology Analytical Services, 825 South Eighth Street, Suite 816, Minneapolis, MN 55404. Phone: 612-347-5811; Fax: 612-347-5878.

Abstract. The association between hematocrit level and future hospitalization risks in hemodialysis patients has not been fully investigated on a national level. A total of 71,717 prevalent Medicare hemodialysis patients who survived a 6-mo entry period from July 1 through December 31, 1993 were studied, and their risk of hospitalizations was evaluated the next year. Five hematocrit groups were defined from Medicare recombinant human erythropoietin-treated patients: <27%, 27 to <30%, 30 to <33%, 33 to <36%, and >=36%. A Cox regression model was used to investigate the association between hematocrit level and the risk of first hospitalization, and the Andersen-Gill regression model evaluated multiple hospitalizations during the next year, adjusting for patient comorbidity and severity of disease. Compared with the baseline group of 30 to <33%, patients with hematocrit levels <30% had a 14 to 30% increased risk of hospitalization without disease severity adjustment (p = 0.0001) and a 7 to 18% increased risk with disease severity adjustment (p = 0.0001). Patients in the 33 to <36% group had the lowest risk at 0.93 and 0.88 (p = 0.0001), with and without adjustment for disease severity. It is concluded that patients with hematocrits of <30% have an increased risk of future hospitalization, with hematocrit levels between 33 and 36% having the lowest associated risks.




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