Target Hemoglobin Levels in Older Patients with CKD

Mood, gait, and balance, muscle strength and activities of daily living are key parameters of functional assessment in older individuals. Using best performance in those parameters, Osman Kara, MD, and colleagues sought to determine target hemoglobin values in older patients with chronic kidney disease (CKD). Results of the assessment were reported online in Aging Clinical and Experimental Research [doi.org/10.1007/s40520-022-02246-1].

The researchers recorded patients’ age, sex, education level, and comorbidities. All study participants underwent comprehensive geriatric assessment (CGA) that included functional assessment using the Basic and Instrumental Activities of Daily Living tool, the Tinetti Performance-Oriented Mobility Assessment, the Timed Up and Go Test assessment of fall risk, and assessment of handgrip strength as a surrogate for muscle strength. Hemoglobin levels and kidney functions were assessed on the same day as the CGA measurements. The optimum level of hemoglobin according to the best performance of CGA parameters was detected using receiver operating characteristic (ROC) analysis.

The study cohort included 622 elderly patients with CKD; of those 69.3% were women and 55.7% had anemia. Following adjustment for confounders, the women with anemia had dynapenia (odds ratio, 1.60), high risk of falls (OR, 1.60), and decreased functional ability (OR, 1.83). The men with anemia had dynapenia (OR, 4.31), a high risk of falls (OR, 2.42), and decreased functional ability (OR, 2.94).

Based on the ROC analyses, the optimum value of hemoglobin level in women was 11.8-12.1 g/dL; in men, the optimum value of hemoglobin value was 12.6-12.8 g/dL.

In conclusion, the authors said, “Anemia is associated with dynapenia, high risk of falls, and decreased functional capacity in older CKD patients regardless of genericity. To prevent these negative outcomes, hemoglobin should be kept in the range of 11.8-12.2 in older females with CKD and 12.6-12.8 in older males with CKD.”