Prevalence and management of anemia in hemodialysis patients in a Brazilian population of predominantly African descent

Background/Objective: Findings from the international DOPPS indicated a rise in hemoglobin levels for patients on maintenance hemodialysis (MHD) for more than 180 days across many countries with more than 60% with hemoglobin >= 11 g/dl. However, the situation of anemia control for a large contingent of the hemodialysis population remains unknown. Studies in the United States indicate that hemoglobin level is lower for African Americans on MHD, but studies in other populations of African descent are lacking. We investigated the prevalence of, and associated factors for, hemoglobin <11 g/dl in MHD patients from the Brazilian city with the largest proportion of African descendants outside Africa. Methods: Cross-sectional study of 1,263 MHD patients enrolled in the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO) in Salvador, Brazil 2005-2009. Results: 88.0% black or mixed race; age 49.0 +/- 14.7 years; 96.6% receiving erythropoietin, median = 6,000 units/week. In patients on MHD for more than 180 days, 67.4% had hemoglobin <11 g/dl. Factors associated with hemoglobin <11 g/dl were MHD by catheter (odds ratio (OR) = 3.03, 95% confidence interval (CO = 1.43-6.42), hospitalization in prior 3 months (OR = 2.14, 95% CI = 1.20-3.83), transferrin saturation <20% (OR = 1.49, 95% CI = 1.05-2.12) and higher malnutrition-inflammation score (OR = 1.58 per each log-transformed unit, 95% Cl = 1.14-2.19). Conclusions: The results suggest that iron deficiency, insufficient elythropoletin dose, catheter use, malnutrition-inflammation, and problems associated with hospitalization are explanations for the high prevalence of hemoglobin below the guideline target in MHD patients from a large African descent Brazilian population. These results have implications for understanding the lower hemoglobin concentration in MHD populations of African descent.