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In Reply: Dr Regidor and colleagues suggest that their observational data¹ are similar to clinical trial results. Figure 1 of their study¹ shows the adjusted relative hazard ratio of death is approximately 1.5 when the hemoglobin level is 10.0 g/dL vs 1.0 when the hemoglobin level is 13.0 g/dL, while the largest dialysis anemia trial achieving those mean values found a 22% higher relative risk of death from a higher hemoglobin level.² The study by Regidor et al¹ also shows that the hazard ratio of death decreases from approximately 1.4 when the hemoglobin level is 10.0 g/dL to 11.0 g/dL to approximately 0.9 when the hemoglobin level is near 12.0 g/dL. However, actual adjusted mortality among US dialysis patients has not changed, although the mean hemoglobin level has steadily increased from 10 g/dL in 1993 to 12.0 g/dL in 2004.³

Regidor et al¹ examined achieved hemoglobin values, yet the writers . . . [Full Text of this Article]

Daniel W. Coyne, MD
dcoyne@im.wustl.edu
Department of Medicine
Washington University School of Medicine
St Louis, Missouri

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