ArticleRenal failure2025
Hemoglobin variability predicts mortality in acute kidney injury patients undergoing continuous renal replacement therapy: a multi-database cohort study.
Article in Renal failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundShort-term hemoglobin variability (Hb-ARV) during continuous renal replacement therapy (CRRT) may reflect blood volume instability in acute kidney injury (AKI), yet its mortality implications remain unclear.
methodsThis multi-database study analyzed adult AKI patients receiving CRRT >24 h from the Medical Information Mart for Intensive Care (MIMIC)-IV, eICU Collaborative Research Database (eICU), Amsterdam University Medical Center (AmsterdamUMC) database, and Jiangsu Province Hospital (JSPH) CRRT database. Hb-ARV, quantifying hemoglobin fluctuations during CRRT, was assessed
resultsThe MIMIC-IV, eICU, AmsterdamUMC, and JSPH cohorts included 1,321, 437, 631, and 488 patients, respectively, with median (IQR) Hb-ARVs of 5.1 (3.9-6.6) g/L, 5.8 (4.1-8.2) g/L, 5.0 (3.9-6.8) g/L, and 6.3 (5.1-8.0) g/L. In-hospital mortality rates were 48.2%, 41.2%, 43.7%, and 44.9%. Restricted cubic splines revealed J-shaped/linear mortality trends with Hb-ARV. Compared to the second quartile of Hb-ARV, the highest quartile was significantly associated with increased in-hospital mortality in MIMIC-IV (adjusted HR 1.32, 95% CI: 1.05-1.66), AmsterdamUMC (adjusted HR 1.74, 95% CI: 1.23-2.46), and JSPH (adjusted HR 1.96, 95% CI: 1.31-2.93) cohorts. In the eICU cohort, where a linear trend was observed, each 1 g/L increase in Hb-ARV was associated with an adjusted HR of 1.07 (95% CI: 1.03-1.11) for in-hospital mortality. Highest quartile of Hb-ARV was also associated with increased 1-year mortality in MIMIC-IV and AmsterdamUMC cohorts.
conclusionsExcessive Hb-ARV during CRRT predict higher short- and long-term mortality in patients with AKI.
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