{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:20:56Z","timestamp":1792027256871,"version":"4.4.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:00:00Z","timestamp":1739232000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:00:00Z","timestamp":1739232000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["24K06239"],"award-info":[{"award-number":["24K06239"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Exp Nephrol"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The optimal hemoglobin (Hb) range in patients undergoing hemodialysis remains controversial. We aimed to investigate the association between Hb levels and mortality in patients undergoing hemodialysis and explore the potential factors modifying this association.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This observational study utilized a nationwide database from the Japanese Renal Data Registry spanning from 2019 to 2021. This study included 265,779 patients undergoing hemodialysis thrice a week. The association between Hb levels and all-cause and cause-specific mortality was investigated using Cox regression analysis. The nonlinear relationship between Hb levels and outcomes was investigated using restricted cubic spline analysis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>During a median follow-up period of 24\u00a0months, 45,734 patients died. Compared to the reference Hb category of 10\u201310.9\u00a0g\/dL, the risk of all-cause mortality was higher in the Hb categories of\u2009&lt;\u20099.0, 9.0\u20139.9, and\u2009\u2265\u200913\u00a0g\/dL with adjusted hazard ratios (95% confidence intervals) of 1.24 (1.20\u20131.29), 1.09 (1.06\u20131.12), and 1.19 (1.14\u20131.25), respectively. Restricted cubic spline analysis also showed a U-shaped relationship between Hb level and mortality. The subgroup analysis indicated that the Hb category of 12.0\u201312.9\u00a0g\/dL was associated with increased mortality risk in patients with a dialysis vintage of\u2009\u2265\u200910\u00a0years and those with a history of cerebral infarction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Hb levels of\u2009&lt;\u200910.0 and\u2009\u2265\u200913.0\u00a0g\/dL were significantly associated with an increased mortality risk compared to an Hb level of 10.0\u201310.9\u00a0g\/dL in patients undergoing hemodialysis.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s10157-025-02632-9","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T16:22:19Z","timestamp":1739290939000},"page":"831-842","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Association between hemoglobin level and mortality in patients undergoing maintenance hemodialysis: a nationwide dialysis registry in Japan"],"prefix":"10.1007","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3696-2263","authenticated-orcid":false,"given":"Takaaki","family":"Kosugi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Hasegawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Imaizumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Nishiwaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirokazu","family":"Honda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiko","family":"Ito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiko","family":"Tsuruya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanori","family":"Abe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norio","family":"Hanafusa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Kuragano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"issue":"1","key":"2632_CR1","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/s0272-6386(96)90130-4","volume":"28","author":"RN Foley","year":"1996","unstructured":"Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. 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TH has no conflicts of interest to disclose. TI received honoraria from GSK. HN has no conflicts of interest to disclose. HH received honoraria from Astellas, Bayer, Chugai, Kissei, Kyowa Kirin, Mitsubishi Tanabe, and Torii. YI received honoraria from Chugai, Kyowa Kirin, Astellas, Mitsubishi Tanabe, Bayer, and Torii. KT received honoraria from Kyowa Kirin, Mitsubishi Tanabe, Astellas, Torii, Bayer, and Chugai and donations from Kyowa Kirin, and Bayer. MA received honoraria from Kyowa Kirin, Bayer Yakuhin, Torii Pharmaceutical, Astellas Pharma, and Mitsubishi Tanabe Pharma. NH has no conflicts of interest to disclose. TKu received research grants from Ono and Kissei and speaker bureaus from Kyowa Kirin, Fuso, Mitsubishi Tanabe, Astellas, AstraZeneca, and Bayer.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the Medicine Ethics Committee of JSDT (approved No. 63) and was conducted in accordance with the Declaration of Helsinki and Ethical Guidelines for Medical and Biological Research Involving Human Subjects issued in March 2022 by the Ministry of Health, Labour and Welfare and the Ministry of Education, Culture, Sports, Science and Technology.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written consent for participation was waived by the Ethics Committee due to the use of anonymized data, the absence of intervention conducted for research purposes, and the provision of the option to decline participation (opt-out).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Patient consent"}}]}}