Cut-off values of hemoglobin and clinical outcomes in incident peritoneal dialysis: the PDTAP study

To explore the cut-off values of hemoglobin on adverse clinical outcomes in the incident PD patients based on a national-level database.The observational cohort study was from the Peritoneal Dialysis Telemedicine-assisted Platform (PDTAP) dataset. The primary outcomes were all-cause mortality, major adverse cardiovascular events (MACE) and modified MACE + . The secondary outcomes were the occurrences of hospitalization, first-episode peritonitis, permanent transfer to hemodialysis.A total of 2 591 PD patients were enrolled between June 2016 and April 2019, and followed-up till December, 2020. Baseline and time-averaged hemoglobin <100 g/L were associated with all-cause mortality, MACE, modified MACE + and hospitalizations. After multivariable adjustments, only time-averaged hemoglobin <100 g/L significantly predicted a higher risk for all-cause mortality [HR 1.83 (1.19, 281), P = 0.006], MACE [HR 1.99 (1.16, 3.40), P = 0.012] and modified MACE+ [HR 1.77 (1.15, 2.73), P = 0.010] in the total cohort. No associations between hemoglobin and hospitalizations, transfer to hemodialysis and first-episode peritonitis were observed. Among patients with hemoglobin ≥100 g/L at baseline, younger age, female, use iron supplementation, lower values of serum albumin and renal kt/v independently predicted the incidence of hemoglobin <100 g/L during the follow up.This study indicated a real-world evidence on the cut-off value of hemoglobin for predicting poorer outcomes through a nation-level prospective PD cohort.