Blood Hemoglobin Concentrations and the Incidence of Lower Extremity Peripheral Arterial Disease in Patients Undergoing Hemodialysis: 10‐Year Outcomes of the Q‐Cohort Study
Background Lower extremity peripheral arterial disease is a potentially lethal cardiovascular complication in patients undergoing hemodialysis. Anemia is a risk factor for cardiovascular disease among the hemodialysis population. However, whether blood hemoglobin concentration is associated with the...
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Wiley
2024-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.033853 |
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| author | Chiaki Kohara Shunsuke Yamada Shigeru Tanaka Hiroto Hiyamuta Hiromasa Kitamura Hokuto Arase Sho Shimamoto Masatomo Taniguchi Kazuhiko Tsuruya Takanari Kitazono Toshiaki Nakano |
| author_facet | Chiaki Kohara Shunsuke Yamada Shigeru Tanaka Hiroto Hiyamuta Hiromasa Kitamura Hokuto Arase Sho Shimamoto Masatomo Taniguchi Kazuhiko Tsuruya Takanari Kitazono Toshiaki Nakano |
| author_sort | Chiaki Kohara |
| collection | DOAJ |
| description | Background Lower extremity peripheral arterial disease is a potentially lethal cardiovascular complication in patients undergoing hemodialysis. Anemia is a risk factor for cardiovascular disease among the hemodialysis population. However, whether blood hemoglobin concentration is associated with the risk of peripheral arterial disease progression in this population remains undetermined. Methods and Results This is an extension of a 4‐year multicenter, prospective, observational cohort study to 10 years. A total of 3504 Japanese patients undergoing maintenance hemodialysis were recruited between 2006 and 2007. The primary exposure was blood hemoglobin concentration at baseline. The main outcome was the first‐ever incidence of major adverse limb events (MALE), composed of endovascular treatment, bypass surgery, and amputation. Multivariable‐adjusted Cox proportional hazards model, Fine–Gray subdistribution hazards model, restricted cubic spline analysis, and restricted mean survival time analysis were used to determine the association of blood hemoglobin concentration with the incidence of MALE. During a median follow‐up of 8.0 years, 257 patients experienced MALE. A Cox proportional hazards model showed that the risk of MALE in patients with blood hemoglobin concentrations <10.0 g/dL was significantly higher than in patients with concentrations of 11.0 to 11.9 g/dL, even after adjusting for confounding factors. In contrast, elevated hemoglobin concentration (≥12.0 g/dL) was not significantly associated with increased risk of MALE. Similar associations were observed when the Fine–Gray subdistribution regression model was used by setting all‐cause mortality as the competing risk. Conclusions A low blood hemoglobin concentration is an independent risk factor for peripheral arterial disease progression in patients undergoing maintenance hemodialysis. |
| format | Article |
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| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-531fafeaf4ac40218a349cbce4f4dc872025-08-20T02:27:32ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-08-01131510.1161/JAHA.123.033853Blood Hemoglobin Concentrations and the Incidence of Lower Extremity Peripheral Arterial Disease in Patients Undergoing Hemodialysis: 10‐Year Outcomes of the Q‐Cohort StudyChiaki Kohara0Shunsuke Yamada1Shigeru Tanaka2Hiroto Hiyamuta3Hiromasa Kitamura4Hokuto Arase5Sho Shimamoto6Masatomo Taniguchi7Kazuhiko Tsuruya8Takanari Kitazono9Toshiaki Nakano10Department of Medicine and Clinical Science, Graduate School of Medical Sciences Kyushu University Fukuoka JapanDepartment of Medicine and Clinical Science, Graduate School of Medical Sciences Kyushu University Fukuoka JapanDepartment of Medicine and Clinical Science, Graduate School of Medical Sciences Kyushu University Fukuoka JapanDepartment of Medicine and Clinical Science, Graduate School of Medical Sciences Kyushu University Fukuoka JapanDepartment of Medicine and Clinical Science, Graduate School of Medical Sciences Kyushu University Fukuoka JapanDepartment of Medicine and Clinical Science, Graduate School of Medical Sciences Kyushu University Fukuoka JapanDepartment of Medicine and Clinical Science, Graduate School of Medical Sciences Kyushu University Fukuoka JapanFukuoka Renal Clinic Fukuoka JapanDepartment of Nephrology Nara Medical University Nara JapanDepartment of Medicine and Clinical Science, Graduate School of Medical Sciences Kyushu University Fukuoka JapanDepartment of Medicine and Clinical Science, Graduate School of Medical Sciences Kyushu University Fukuoka JapanBackground Lower extremity peripheral arterial disease is a potentially lethal cardiovascular complication in patients undergoing hemodialysis. Anemia is a risk factor for cardiovascular disease among the hemodialysis population. However, whether blood hemoglobin concentration is associated with the risk of peripheral arterial disease progression in this population remains undetermined. Methods and Results This is an extension of a 4‐year multicenter, prospective, observational cohort study to 10 years. A total of 3504 Japanese patients undergoing maintenance hemodialysis were recruited between 2006 and 2007. The primary exposure was blood hemoglobin concentration at baseline. The main outcome was the first‐ever incidence of major adverse limb events (MALE), composed of endovascular treatment, bypass surgery, and amputation. Multivariable‐adjusted Cox proportional hazards model, Fine–Gray subdistribution hazards model, restricted cubic spline analysis, and restricted mean survival time analysis were used to determine the association of blood hemoglobin concentration with the incidence of MALE. During a median follow‐up of 8.0 years, 257 patients experienced MALE. A Cox proportional hazards model showed that the risk of MALE in patients with blood hemoglobin concentrations <10.0 g/dL was significantly higher than in patients with concentrations of 11.0 to 11.9 g/dL, even after adjusting for confounding factors. In contrast, elevated hemoglobin concentration (≥12.0 g/dL) was not significantly associated with increased risk of MALE. Similar associations were observed when the Fine–Gray subdistribution regression model was used by setting all‐cause mortality as the competing risk. Conclusions A low blood hemoglobin concentration is an independent risk factor for peripheral arterial disease progression in patients undergoing maintenance hemodialysis.https://www.ahajournals.org/doi/10.1161/JAHA.123.033853anemiablood hemoglobin concentrationhemodialysismajor adverse limb eventsperipheral arterial disease |
| spellingShingle | Chiaki Kohara Shunsuke Yamada Shigeru Tanaka Hiroto Hiyamuta Hiromasa Kitamura Hokuto Arase Sho Shimamoto Masatomo Taniguchi Kazuhiko Tsuruya Takanari Kitazono Toshiaki Nakano Blood Hemoglobin Concentrations and the Incidence of Lower Extremity Peripheral Arterial Disease in Patients Undergoing Hemodialysis: 10‐Year Outcomes of the Q‐Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease anemia blood hemoglobin concentration hemodialysis major adverse limb events peripheral arterial disease |
| title | Blood Hemoglobin Concentrations and the Incidence of Lower Extremity Peripheral Arterial Disease in Patients Undergoing Hemodialysis: 10‐Year Outcomes of the Q‐Cohort Study |
| title_full | Blood Hemoglobin Concentrations and the Incidence of Lower Extremity Peripheral Arterial Disease in Patients Undergoing Hemodialysis: 10‐Year Outcomes of the Q‐Cohort Study |
| title_fullStr | Blood Hemoglobin Concentrations and the Incidence of Lower Extremity Peripheral Arterial Disease in Patients Undergoing Hemodialysis: 10‐Year Outcomes of the Q‐Cohort Study |
| title_full_unstemmed | Blood Hemoglobin Concentrations and the Incidence of Lower Extremity Peripheral Arterial Disease in Patients Undergoing Hemodialysis: 10‐Year Outcomes of the Q‐Cohort Study |
| title_short | Blood Hemoglobin Concentrations and the Incidence of Lower Extremity Peripheral Arterial Disease in Patients Undergoing Hemodialysis: 10‐Year Outcomes of the Q‐Cohort Study |
| title_sort | blood hemoglobin concentrations and the incidence of lower extremity peripheral arterial disease in patients undergoing hemodialysis 10 year outcomes of the q cohort study |
| topic | anemia blood hemoglobin concentration hemodialysis major adverse limb events peripheral arterial disease |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.033853 |
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