Haemoglobin levels and health-related quality of life in young and elderly patients on specialized predialysis care.

Nephrology, Dialysis, Transplantation

PubMedID: 24516235

de Goeij MC, Meuleman Y, van Dijk S, Grootendorst DC, Dekker FW, Halbesma N, for the PREPARE-2 Study Group. Haemoglobin levels and health-related quality of life in young and elderly patients on specialized predialysis care. Nephrol Dial Transplant. 2014;29(7):1391-8.
BACKGROUND
In predialysis patients, the optimal treatment choices for controlling haemoglobin (Hb) are unknown, because targeting high Hb levels has negative effects-poorer survival-but possible positive effects as well-better health-related quality of life (HRQOL). Moreover, these effects may be different in specific subgroups (e.g. young versus elderly).

METHODS
In the PREPARE-2 follow-up study, incident predialysis patients were included (2004-2011) when referred to 1 of the 25 participating Dutch outpatient clinics. HRQOL was assessed at 6-month intervals with the short form-36 (SF-36) questionnaire [physical/mental summary measure and eight subscales (range 0-100)]. A linear mixed model was used to associate Hb [<11, =11 to <12 (reference), =12 to <13 and =13 g/dL] with HRQOL, stratified by prescription of anaemia medication (erythropoietin-stimulating agent (ESA)/iron) and age (young: <65 years and elderly: =65 years).

RESULTS
Only elderly patients (n = 214) not prescribed ESA/iron and with a high Hb (=13 versus =11 to <12 g/dL) had a statistically significant (P < 0.05) and/or clinically relevant (>3-5 points) higher physical [11.9, 95% confidence interval (CI) 1.7, 22.2] and mental (6.4, 95% CI -1.7, 14.6) summary score. High Hb was not associated with a higher HRQOL in elderly patients who were prescribed ESA/iron. However, only young patients (n = 157) prescribed ESA/iron and with a high Hb (=13 versus =11 to <12 g/dL) had a higher physical (8.9, 95% CI 2.1, 15.8) and mental (6.2, 95% CI -0.4, 12.8) summary score.

CONCLUSIONS
The association of Hb levels with HRQOL differs by age and use of ESA/iron medication on predialysis care. Therefore, medical care should aim for shared decision-making regarding the appropriate Hb target leading to more individualized care.