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Article Dans Une Revue Nephrology Dialysis Transplantation Année : 2023

Haemoglobin trajectories in chronic kidney disease and risk of major adverse cardiovascular events

Natalia Alencar de Pinho
  • Fonction : Auteur
Christian Combe
  • Fonction : Auteur
Denis Fouque
  • Fonction : Auteur
Luc Frimat
  • Fonction : Auteur
Aghilès Hamroun
Christian Jacquelinet
  • Fonction : Auteur
Maurice Laville
  • Fonction : Auteur
Ziad Massy
  • Fonction : Auteur
Christophe Pascal
  • Fonction : Auteur
Roberto Pecoits-Filho
  • Fonction : Auteur
Bénédicte Stengel
  • Fonction : Auteur
Céline Lange
  • Fonction : Auteur
Oriane Lambert
  • Fonction : Auteur
Marie Metzger
  • Fonction : Auteur

Résumé

Background Trajectories of haemoglobin in patients with chronic kidney disease (CKD) have been poorly described. In such patients, we aimed to identify typical haemoglobin trajectory profiles and estimate their risks of major adverse cardiovascular events (MACE). Methods We used 5-year longitudinal data from the CKD-REIN cohort patients with moderate to severe CKD enrolled from 40 nationally representative nephrology clinics in France. A joint latent class model was used to estimate, in different classes of haemoglobin trajectory, the competing risks of (i) MACE + defined as the first event among cardiovascular death, non-fatal myocardial infarction, stroke or hospitalization for acute heart failure, (ii) initiation of kidney replacement therapy (KRT), and (iii) non-cardiovascular death. Results During the follow-up, we gathered 33 874 haemoglobin measurements from 3 011 subjects (median, 10 per patient). We identified five distinct haemoglobin trajectory profiles. The predominant profile (n = 1885, 62.6%) showed an overall stable trajectory and low risks of events. The four other profiles had nonlinear declining trajectories: early strong decline (n = 257, 8.5%), late strong decline (n = 75, 2.5%), early moderate decline (n = 356, 11.8%) and late moderate decline (n = 438, 14.6%). The four profiles had different risks of MACE, while the risks of KRT and non-cardiovascular death consistently increased from the haemoglobin decline. Conclusion In this study, we observed that two third of patients had stable haemoglobin trajectory and low risks of adverse events. The other third had a nonlinear trajectory declining at different rates, with increased risks of events. A better attention to dynamic changes of haemoglobin in CKD should be paid.
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Dates et versions

hal-04284734 , version 1 (14-11-2023)

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Lisa Le Gall, Jérôme Harambat, Christian Combe, Viviane Philipps, Cécile Proust-Lima, et al.. Haemoglobin trajectories in chronic kidney disease and risk of major adverse cardiovascular events. Nephrology Dialysis Transplantation, 2023, ⟨10.1093/ndt/gfad235⟩. ⟨hal-04284734⟩
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