The association between anemia and mortality in hemodialysis patients is inconsistent in different blood glucose levels.

Aims: To evaluate if the association between anemia and mortality is affected by blood glucose levels in hemodialysis patients.

Materials and methods: A total of 818 consecutive patients who started hemodialysis between January 2013 and December 2016 were included in this study, followed until December 2022. Patients were categorized into five HbA1c groups (< 5%, 5 - 5.9%, 6 - 6.9%, 7 - 7.9%, and ≥ 8%) and six hemoglobin (Hb) groups (< 9, 9 - 10, 10 - 11, 11 - 12, 12 - 13, and > 13 g/dL). Kaplan-Meier survival analysis and multivariate Cox regression were performed to evaluate the association between Hb levels and all-cause mortality, adjusting for confounders.

Results: There were 310 (37.9%) deaths during a maximum follow-up of 120 months. Lower Hb levels were significantly associated with increased mortality risk (p for trend < 0.01). However, subgroup analysis revealed a significant interaction between Hb and HbA1c levels (p for interaction < 0.01). In patients with HbA1c < 5% and 5 - 5.9%, lower Hb levels (< 11 g/dL) were associated with a higher risk of mortality (p for trend < 0.05). In contrast, in patients with HbA1c ≥ 6%, Hb levels were not significantly associated with mortality risk (p for trend > 0.05).

Conclusion: The association between anemia and mortality in hemodialysis patients varies across HbA1c levels. Lower Hb levels were associated with increased mortality risk in patients with HbA1c < 6%, whereas this association was not observed in those with HbA1c ≥ 6%.