Association between hematocrit level and mortality in hemodialysis patients. Case study of the anemic patient.

A large, 4-year, retrospective study of the HCFA end-stage renal disease (ESRD) claims database, Parts A and B, was conducted to determine the association between hematocrit (Hct) level and survival in patients on hemodialysis. Patients who survived the last 6 months of each year and had at least 4 Epoetin alfa claims qualified for the study. Cohort entry years were 1990 through 1993, with the relative risk (RR) of mortality evaluated during the following year. Patients were stratified into four groups on the basis of mean Hct levels in the 6-month entry period: < 27%, 27% to < 30%, 30% to < 33%, and 33% to 36%. Using the 30% to < 33% Hct group as reference (relative risk (RR) = 1), patients whose mean 6-month Hct was in the 33% to 36% range were associated with significantly lower RR of mortality, while patients whose mean 6-month Hct was below 30% were associated with significantly higher RR of mortality. This epidemiologic study highlighted an important association between higher hematocrits in hemodialysis patients and lower RR of mortal.