Anemia and Survival in Thai Hemodialysis Patients: Evidence from National Registry Data
Udom Krairittichai MD*, Thanom Supaporn MD*, Pote Aimpun MD, DrPH*, Adisorn Wangsiripaisan MD*, Amnart Chaiprasert MD*, Amporn Sakulsaengprapha MD*, Anutra Chittinandana MD*, Wipa Thanachartwet MD*, Valai Palasawatdhi BN*, Soysaang Srangsomwong BN*
Affiliation : * Thailand Renal Replacement Therapy Registry, Nephrology Society of Thailand
Background : Anemia is a major contributor to morbidity and mortality in chronic dialysis patients. The K/
DOQI guideline recommends the target hemoglobin of 11-12 g/dl (hematocrit of 33-36%). However, the
appropriate hematocrit level for Thai hemodialysis patients has been controversial.
Objective : To investigate the influence of anemia on mortality in Thai chronic hemodialysis patients who
initiated their dialysis from 1999 through 2003.
Materials and Methods : The data from the Thailand Renal Replacement Therapy Registry who has conducted
an annual report of chronic dialysis patients throughout Thailand since 1997 was used. Data of twice- and
thrice-weekly hemodialysis patients who had recorded hematocrit from 1999 through 2003 were processed
and confirmed before final analysis. Records of 3,211 hemodialysis patients from 301 centers were included.
Result: The original kidney diseases were diabetes mellitus (31.5%) and hypertension (20.9%). Most patients
received twice-weekly hemodialysis (86.3%). The mean hematocrit was 29.3(cid:31)5.5%. Most patients (72.8%)
had hematocrits of less than 33%. Kaplan-Meier analysis showed patients with hematocrit of ?33% or more
had better survival than patients with hematocrits of less than 33% (p <0.01). Patients with hematocrits of less
than 27, 27-29.9, 30-32.9 and 36% or more had mortality risks of 1.90 (95% CI: 1.31-2.76, p <0.01), 2.10
(95% CI: 1.42-3.09, p <0.01), 1.74 (95% CI: 1.18-2.56, p <0.01) and 1.174 (95% CI: 0.73-1.90, p = 0.51)
respectively, compared to those with hematocrit of 33-35.9%.
Conclusion : The best survival can be achieved in Thai patients with hematocrits of at least 33%.
Keywords : Anemia, Hemodialysis, Mortality
