Red blood cell transfusion, hyperkalemia, and heart failure in advanced chronic kidney disease.

Abstract

PURPOSE:

In recent years, the use of red blood cell (RBC) transfusion for the treatment of chronic kidney disease (CKD)-related anemia has increased. We used the OptumInsight medical claims database to study the association between receiving a transfusion and hyperkalemia and heart failure events.

METHODS:

Persons 18-64 years of age with diagnosed stage 4 or 5 CKD (not requiring dialysis) between 2006 and 2010 were followed until their first hospitalization or emergency room visit with a diagnosis of hyperkalemia or heart failure, termination of insurance coverage, or death. We used a case-only design and conditional logistic regression to estimate rate ratios (RR) and 95% confidence intervals (CIs) describing associations between RBC transfusion and the risks of hyperkalemia or heart failure. We used single (1:1) and variable (1:m) self-control matching intervals, with adjustment for time-varying confounders.

RESULTS:

Seven thousand eight hundred twenty-nine individuals met our inclusion criteria; two-thirds were age 50 years or older; 43% were women and 51% had diabetes. Rates of hyperkalemia and heart failure were 7.9/100 person-years (95%CI: 7.3, 8.5) and 16.3/100 person-years (95%CI: 15.5, 17.2), respectively. RBC transfusion was associated with an increased risk of both hyperkalemia (single interval matched RR = 12.0, 95%CI: 1.3, 109; multiple interval matched RR = 6.1, 95%CI: 2.5, 15.1) and heart failure (single interval matched RR = 1.7, 95%CI: 0.3, 9.2; multiple interval matched RR = 3.8, 95%CI: 1.4, 10.3).

CONCLUSION:

In patients with advanced CKD, RBC transfusion appears to be associated with an elevated risk of hyperkalemia and heart failure; further investigation into these risks is warranted.

• Authors: Karminder Gill, Jeffrey C Fink, David T Gilbertson, Keri L Monda, Paul Muntner, Richard A Lafayette, Jeffrey Petersen, Glenn M Chertow, Brian D Bradbury
• Journal: Pharmacoepidemiology and drug safety (Pharmacoepidemiol Drug Saf) Vol. 24 Issue 6 Pg. 654-62 (Jun 2015) ISSN: 1099-1557 [Electronic] England
• PMID: 25903095 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 John Wiley & Sons, Ltd.

Topics

• Adolescent
• Adult
• Aged
• Databases, Factual
• Erythrocyte Transfusion (statistics & numerical data)
• Female
• Heart Failure (complications, epidemiology)
• Humans
• Hyperkalemia (complications, epidemiology)
• Insurance Claim Review
• Male
• Middle Aged
• Renal Insufficiency, Chronic (complications, epidemiology, mortality)
• United States (epidemiology)
• Young Adult