{
  "abstract": "Background/Objectives: Hemoglobin may identify differences in prognosis among patients with advanced chronic kidney disease (CKD) and documented myocardial ischemia. We examined the shape of its association with clinical outcomes in ISCHEMIA-CKD. Methods: This exploratory observational secondary analysis included 758 randomized participants with baseline hemoglobin. The primary endpoint was the parent-trial composite of all-cause death or myocardial infarction (MI). Adjusted Cox regression with restricted cubic splines characterized the hemoglobin association. Mortality and pooled nonfatal MI were examined using Cox and competing-risk models. Results: Median hemoglobin was 11.1 g/dL; 247 participants experienced the primary endpoint. The adjusted association departed from log-linearity (p = 0.015), with higher hazard at lower hemoglobin and an uncertain upper limb. Relative to 11.1 g/dL, the hazard ratio (HR) at 8 g/dL was 1.98 (95% confidence interval [CI] 1.26–3.10). As a linear summary, the HR per 1 g/dL lower hemoglobin was 1.13 (95% CI 1.04–1.23) for the primary endpoint. Corresponding mortality associations were present, whereas pooled nonfatal MI showed no clear association (subdistribution HR 1.03, 95% CI 0.89–1.21). Exploratory treatment interaction tests provided no convincing evidence of effect modification (linear p = 0.059; spline p = 0.124). Conclusions: Among selected, clinically stable participants with advanced CKD and moderate-to-severe ischemia, lower baseline hemoglobin was associated with adverse prognosis. Nonlinearity and uncertainty at higher values argue against a single summary estimate or an inferred optimal target. These potentially confounded findings neither establish benefit from hemoglobin correction nor support hemoglobin-based selection of invasive versus conservative management.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, Acıbadem Bayındır Söğütözü Hospital, Ankara 06250, Türkiye",
    "Department of Cardiology, School of Medicine, Ankara Medipol University, Ankara 06050, Türkiye"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Anar Mammadli"
    },
    {
      "affs": [
        1
      ],
      "name": "Erdem Diker"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8ceddsxdd2m55.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15218610",
  "fulltext_url": null,
  "id": "8ceddsxdd2m55",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/21/8610",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-05",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/8ceddsxdd2m55.ris",
  "sources": [
    {
      "first_seen": "2026-11-05T12:21:24Z",
      "native_id": "10.3390/jcm15218610",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/21/8610"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "journal-openalex:F27",
      "subfield": "general"
    }
  ],
  "title": "Baseline Hemoglobin and Outcomes in Advanced Chronic Kidney Disease with Moderate-to-Severe Myocardial Ischemia: A Secondary Analysis of the ISCHEMIA-CKD Trial",
  "title_text": "Baseline Hemoglobin and Outcomes in Advanced Chronic Kidney Disease with Moderate-to-Severe Myocardial Ischemia: A Secondary Analysis of the ISCHEMIA-CKD Trial",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T00:21:23Z",
  "url": "https://research.draconitic.com/paper/8ceddsxdd2m55",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}