Abstract
Hemoglobin variability (Hb-var) in patients with chronic kidney disease has been stipulated to be a result of exogenous treatment with erythropoiesis stimulating agents (ESA) and has been related to mortality in dialysis patients. We hypothesized the existence of Hb-var independent of ESA administration and compared it to that in healthy adults using data from the Scripps-Kaiser and NHANES III databases. We studied the Hb-var in 1571 peritoneal dialysis patients which included 116 patients not requiring treatment with erythropoietin. We systematically studied the differences between the groups that needed ESA therapy and those who did not. White race and male sex were significant predictors of need for erythropoietin therapy. We found peritoneal dialysis patients to exhibit significantly increased Hb-var independent of treatment with exogenous erythropoietin (0.99 gm/dL vs. 1.17 gm/dL, p-value<0.001). We found age to be a significant determinant of Hb-var in the ESA treated group. Hb-var in younger patients (<30 years) was increased by 50% compared to young healthy adults. The Hb-var in elderly (>60 years) peritoneal dialysis patients was similar to that seen in healthy elders, suggesting similarity with anemia of aging. We conclude that exogenous ESA administration does not explain Hb-var entirely but may enhance it. Intrinsic factors affecting erythropoiesis including age may be the major determinants of Hb-var.
Highlights
The basal rate of Red Blood Cell (RBC) production is diminished in patients with chronic kidney disease (CKD)
Prevalent peritoneal dialysis patients receiving services for 6 months or longer at any of the centers operated by Dialysis Clinic Inc., a large nonprofit dialysis provider in the United States between January 2007 and December 2009 were included in this study
colony forming units (CFU) are capable of differentiating into mature RBC under the influence of hormone erythropoietin produced by the kidneys
Summary
The basal rate of Red Blood Cell (RBC) production is diminished in patients with chronic kidney disease (CKD). A large variability has been observed in the hemoglobin level of dialysis patients treated with ESAs [5]. Several investigations [6,7,8,9,10,11] have focused exclusively on the effects of ESA on Hb-var in hemodialysis patients. This phenomenon has been called Hb cycling [5,12] by clinical epidemiologists and has been related to mortality [13,14,15,16] and cardiovascular outcomes
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