Garrancho JM et al. (2005) Haemoglobin level and vascular access survival in haemodialysis patients. Nephrol Dial Transplant 20: 2453–2457

In renal disease patients on dialysis, the correction of anemia has clear benefits, including an improvement in quality of life. There is some evidence, however, that this intervention increases the risk of vascular access thrombosis. These factors have been studied by Garrancho and colleagues.

The investigators recruited 1,254 consecutive dialysis patients with arteriovenous fistulae (n = 1,057), grafts (n = 75) or permanent catheters (n = 122) as their first vascular access for hemodialysis, which had begun <1 month previously. During the 9-month follow-up, hemoglobin levels were within the range 100–120 g/l in the majority of cases.

Vascular access failure was more than twice as likely in patients with grafts as in those with arteriovenous fistulae. It is noted that these two groups differed in terms of the proportion of male and female patients, the prevalence of diabetes and other factors. Among the arteriovenous fistulae group, the analysis revealed a significant, 1.8-fold increased risk of vascular access failure in the patients with severe anemia (hemoglobin <100 g/l) compared with hemoglobin levels of 100–120 g/l. Patients with near-normal hemoglobin levels (>120 g/l), however, did not appear to be at increased risk of vascular access failure in either the fistulae or grafts groups.

Commenting on various protective and negative predictive factors also studied, the authors conclude that correction of anemia did not confer risk of vascular access failure in this population.