# Analysis of factors influencing hemoglobin target achievement in maintenance hemodialysis patients in Wuhan, China

## TL;DR

This study identifies factors affecting hemoglobin levels in dialysis patients in Wuhan, China, to help improve anemia management.

## Contribution

The study provides a comprehensive analysis of both clinical and socioeconomic factors influencing hemoglobin target achievement in a large cohort of dialysis patients.

## Key findings

- Female sex, lower dialysis frequency, and higher serum phosphorus are risk factors for not achieving hemoglobin targets.
- Use of LMWH and higher serum albumin are protective factors for achieving hemoglobin targets.
- Socioeconomic factors like insurance coverage also influence hemoglobin target achievement.

## Abstract

This study identified key factors influencing hemoglobin (Hb) target achievement (≥110 g/L) in maintenance hemodialysis (MHD) patients in Wuhan to guide improvement strategies.

A multicenter retrospective study (January 2019–December 2023) included 4,906 MHD patients from 70 dialysis centers in Wuhan. Data on demographics, dialysis-related parameters, pre-dialysis laboratory indices, and medication use were collected. Patients were categorized into target (Hb ≥ 110 g/L) and non-target group (Hb < 110 g/L). Group differences were analyzed, and binary multivariate logistic regression identified independent factors.

A total of 4,906 MHD patients from 70 dialysis centers were included in this study. Multivariate logistic regression analysis identified female sex (OR = 1.18, p = 0.011), TCC use (OR = 1.23, p = 0.006), dialysis frequency <3 times/week (OR = 1.20, p = 0.006), pre-dialysis hypertension (OR = 1.28, p < 0.001), lack of LC use (OR = 1.16, p = 0.043), higher serum phosphorus (pre 0.1 mmol/L OR = 1.02, p < 0.001) and CRP (pre 1 mg/dL OR = 1.01, p < 0.001) as independent risk factors for not achievement. Independent protective factors included LMWH use (OR = 0.59, p = 0.002), coverage under employee medical insurance (OR = 0.74, p = 0.033), higher serum albumin (pre 1 g/L OR = 0.90, p < 0.001), calcium (per 0.1 mmol/L OR = 0.95, p < 0.001), and TSAT (pre 1% OR = 0.99, p < 0.001).

Hb target achievement in Wuhan MHD patients is influenced by a complex interplay of demographic (sex), clinical (vascular access type, dialysis adequacy and frequency, blood pressure management, inflammatory status, mineral/nutrition/iron status), therapeutic (LMWH and LC management), and socioeconomic factors (insurance). Targeting modifiable factors is crucial for optimizing anemia management.