Hemoglobin levels above 12.5 g/dl achieved by erythropoietin stimulating agents in renal transplant recipients are associated with elevated mortality: a cohort study.

The use of erythropoietin stimulating agents in renal transplant recipients with hemoglobin above 12.5 g/dl is associated with elevated mortality

G. Heinze(1), A. Kainz(2), W. H. Hörl(2), R. Oberbauer(2,3,4)

1- Core Unit of Medical Statistics and Informatics, Medical University of Vienna, Austria

2- Department of Nephrology, Medical University of Vienna, Austria

3- Department of Nephrology, KH Elisabethinen, Linz, Austria

4- Austrian Dialysis and Transplant Registry, Austria

 

// Figures

Webfigure 1:
Webfigure 1:

Adjusted hazard ratio for ESA users (top) and non-users (bottom) at various hemoglobin levels vs. a reference level of 12.5 g/dl. Gray: original analysis (excluding deaths up to day 90), black: analysis including deaths up to day 90.

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Webfigure 2:
Webfigure 2:

Adjusted hazard ratios of ESA users vs. non-users at various hemoglobin levels. Gray: original analysis (excluding deaths up to day 90), black: analysis including deaths up to day 90.

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Webfigure 3:
Webfigure 3:

Adjusted hazard ratio for ESA users (top) and non-users (bottom) at various hemoglobin levels vs. a reference level of 12.5 g/dl. Gray: original analysis (multiple imputation; N=1794, 286 events), black: analysis using complete cases only (N=1386, 208 events).

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Webfigure 4:
Webfigure 4:

Adjusted hazard ratios of ESA users vs. non-users at various hemoglobin levels. Gray: original analysis (multiple imputation; N=1794, 286 events), black: analysis using complete cases only (N=1386, 208 events).

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Webfigure 5:
Webfigure 5:

Adjusted hazard ratio for ESA users (top) and non-users (bottom) at various hemoglobin levels vs. a reference level of 12.5 g/dl. Gray: original analysis (multiple imputation; N=1794, 286 events), black: analysis after multiple imputation of artificially generated nonrandomly missing data.

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Webfigure 6:
Webfigure 6:

Adjusted hazard ratios of ESA users vs. non-users at various hemoglobin levels. Gray: original analysis (multiple imputation; N=1794, 286 events), black: analysis after multiple imputation of artificially generated nonrandomly missing data.

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Webfigure 7:
Webfigure 7:

Adjusted hazard ratio for ESA users (top) and non-users (bottom) at various hemoglobin levels vs. a reference level of 12.5 g/dl. Gray: original analysis (multiple imputation; N=1794, 286 events), black: analysis including time-dependent effects for cholesterol level and number of antihypertensive drugs.

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Webfigure 8:
Webfigure 8:

Adjusted hazard ratios of ESA users vs. non-users at various hemoglobin levels. Gray: original analysis (multiple imputation; N=1794, 286 events), black: analysis after including time-dependent effects for cholesterol level and number of antihypertensive drugs.

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Webfigure 9:
Webfigure 9:

Adjusted hazard ratio for ESA users (top) and non-users (bottom) at various hemoglobin levels vs. a reference level of 12.5 g/dl. Gray: original analysis (multiple imputation; N=1794, 286 events), black: analysis including nonlinear effects for cholesterol level.

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Webfigure 10:
Webfigure 10:

Adjusted hazard ratios of ESA users vs. non-users at various hemoglobin levels. Gray: original analysis (multiple imputation; N=1794, 286 events), black: analysis after including nonlinear effects for cholesterol level.

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Webfigure 11:
Webfigure 11:

Adjusted hazard ratio for ESA users (top) and non-users (bottom) at various hemoglobin levels vs. a reference level of 12.5 g/dl. Gray: original analysis (multiple imputation; N=1794, 286 events, follow-up until 31 Dec 2004), black: analysis including follow-up data until 31 Dec 2008 (313 events).

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Webfigure 12:
Webfigure 12:

Adjusted hazard ratios of ESA users vs. non-users at various hemoglobin levels. Gray: original analysis (multiple imputation; N=1794, 286 events, follow-up until 31 Dec 2004), black: similar, but follow-up until 31 Dec 2008 (313 events)

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Webfigure 13:
Webfigure 13:

Adjusted hazard ratio for ESA users (top) and non-users (bottom) at various hemoglobin levels vs. a reference level of 12.5 g/dl. Gray: original analysis (multiple imputation; N=1794, 286 events, follow-up until 31 Dec 2004), black: analysis excluding cardiovascular disease variables from final model.

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Webfigure 14:
Webfigure 14:

Adjusted hazard ratios of ESA users vs. non-users at various hemoglobin levels. Gray: original analysis (multiple imputation; N=1794, 286 events, follow-up until 31 Dec 2004), black: analysis excluding cardiovascular disease variables

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Webfigure 15:
Webfigure 15:

Adjusted hazard ratio for ESA users (top) and non-users (bottom) at various hemoglobin levels vs. a reference level of 12.5 g/dl. Gray: original analysis (multiple imputation; N=1794, 286 events, follow-up until 31 Dec 2004), black: analysis with ESA users left in ESA user group even after the time point where treatment is stopped.

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Webfigure 16:
Webfigure 16:

Adjusted hazard ratios of ESA users vs. non-users at various hemoglobin levels. Gray: original analysis (multiple imputation; N=1794, 286 events, follow-up until 31 Dec 2004), black: analysis with ESA users left in ESA user group even after the time point where treatment is stopped.

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Webfigure 17:
Webfigure 17:

Adjusted hazard ratio for ESA users (top) and non-users (bottom) at various hemoglobin levels vs. a reference level of 12.5 g/dl. Gray: original analysis of patient survival (multiple imputation; N=1794, 286 events, follow-up until 31 Dec 2004), black: analysis of transplant survival (graft loss and death counted as event; N=1794, 367 events).

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Webfigure 18:
Webfigure 18:

Adjusted hazard ratios of ESA users vs. non-users at various hemoglobin levels. Gray: original analysis of patient survival (multiple imputation; N=1794, 286 events, follow-up until 31 Dec 2004), black: analysis of transplant survival (graft loss and death counted as event; N=1794, 367 events).

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Webfigure 19:
Webfigure 19:

Adjusted hazard ratio for ESA users (top) and non-users (bottom) at various hemoglobin levels vs. a reference level of 12.5 g/dl. Gray: original analysis of patient survival (multiple imputation; N=1794, 286 events, follow-up until 31 Dec 2004), black: analysis additionally adjusting for primary indication for transplantation (diabetes, immune mediated, PCKD, or other).

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Webfigure 20:
Webfigure 20:

Adjusted hazard ratios of ESA users vs. non-users at various hemoglobin levels. Gray: original analysis of patient survival (multiple imputation; N=1794, 286 events, follow-up until 31 Dec 2004), black: analysis additionally adjusting for primary indication for transplantation (diabetes, immune mediated, PCKD, or other).

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