Mortality in renal transplant recipients given erythropoietins to increase haemoglobin concentration: cohort study
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4018 (Published 23 October 2009) Cite this as: BMJ 2009;339:b4018
- Georg Heinze, research scientist1,
- Alexander Kainz, research scientist2,
- Walter H Hörl, professor and head of department2,
- Rainer Oberbauer, professor23, head of department4
- 1Core Unit of Medical Statistics and Informatics, Medical University of Vienna, 1090 Vienna, Austria
- 2Department of Nephrology, Medical University of Vienna, 1090 Vienna, Austria
- 3Austrian Dialysis and Transplant Registry, 4010 Linz, Austria
- 4Department of Nephrology, KH Elisabethinen, 4010 Linz, Austria
- Correspondence to: R Oberbauer, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria rainer.oberbauer{at}meduniwien.ac.at
- Accepted 3 August 2009
Abstract
Objective To determine the optimal range of increase in haemoglobin concentration with treatment with erythropoietins that is safe and is not associated with mortality.
Design Retrospective cohort study. The analysis was adjusted for several covariables with Cox regression analysis with spline functions. Use of erythropoietins, haemoglobin concentration, and covariables were included in a time varying manner; variable selection was based on the purposeful selection algorithm.
Setting Transplantation centres in Austria.
Participants 1794 renal transplant recipients recorded in the Austrian Dialysis and Transplant Registry who received a transplant between 1 January 1992 and 31 December 2004 and survived at least three months.
Main outcome measures Survival time and haemoglobin concentration after treatment with erythropoietins.
Results The prevalence of use of erythropoietins has increased over the past 15 years to 25%. Unadjusted extended Kaplan-Meier analysis suggests higher mortality in patients treated with erythropoietins, in whom 10 year survival was 57% compared with 78% in those not treated with erythropoietins (P<0.001). In the treated patients there were 5.4 events/100 person years, compared with 2.6 events/100 person years in those not treated (P<0.001). After adjustment for confounding by indication, comorbidities, comedication, and laboratory readings, haemoglobin concentrations >125 g/l were associated with increased mortality in treated patients (hazard ratio 2.8 (95% confidence interval 1.0 to 7.9) for haemoglobin concentration 140 g/l v 125 g/l), but not in those not treated (0.7, 0.4 to 1.5). When haemoglobin concentrations were 147 g/l or above, patients treated with erythropoietins showed significantly higher mortality than those who were not treated (3.0, 1.0 to 9.4).
Conclusion Increasing haemoglobin concentrations to above 125 g/l with erythropoietins in renal transplant recipients is associated with an increase in mortality. This increase was significant at concentrations above 140 g/l.
Footnotes
We thank the administrators and all contributors of the Austrian Dialysis and Transplant Registry.
Contributors: GH and RO performed statistical analysis and wrote the paper. AK and WHH wrote part of the paper and maintained the database. RO is the guarantor.
Funding: This study was funded by the Austrian Science Fund (P-18325-B13 to R.O.) and the Austrian Academy of Sciences.
Competing interests: None declared.
Ethical approval: Not required.
Data sharing: No additional data available.
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