Factors Influencing Hemoglobin Variability and Its Association with Mortality in Hemodialysis Patients.

Zeynep Bal,Siren Sezer,Bahar Gurlek Demirci,Mehtap Erkmen Uyar,Emre Tutal,Nurhan Ozdemir Acar,Suleyman Karakose

doi:10.1155/2018/8065691

Abstract

Purpose We aimed to investigate the factors influencing hemoglobin variability with inflammatory and nutritional parameters and its associations with all-cause mortality among hemodialysis patients. Methods One hundred and sixty-nine patients during the entire 12 months were enrolled into the study. Fasting plasma glucose, creatinine, calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH), C-reactive protein (CRP), serum iron, serum iron-binding capacity, and transferrin saturation were analyzed. We defined six groups: low, target range, high, low-amplitude fluctuation with low hemoglobin levels, low-amplitude fluctuation with high hemoglobin levels, and high-amplitude fluctuation. Body mass index (BMI), malnutrition-inflammation score (MIS), and Charlson Comorbidity Index were evaluated. Results Hemoglobin variability was significantly correlated with age, platelet count, and number of hospitalization instances and inversely correlated with erythropoietin dose per body surface area. The coefficient of variation of hemoglobin showed a correlation with MIS and ferritin. The absolute level of hemoglobin showed a negative correlation between PTH, CRP, MIS, number of hospitalization instances and a positive correlation with albumin and BMI. High, low, and target-range groups showed survival advantage compared to the other three groups. In regression analysis, age, CRP levels, MIS, and BMI were the predictors of mortality. Conclusion Inflammation and duration of anemia were the major predictors of hemoglobin variability. High-amplitude fluctuation predicts high mortality; on the contrary low-amplitude fluctuations is related to better survival. MIS was independently associated with mortality. This trial is registered with NCT03454906.

Highlights

Anemia is a common complication of chronic kidney disease (CKD)
The optimal target hemoglobin concentration in CKD remains a matter of considerable uncertainty, the European Best Practice Guidelines (EBPG) recommended that the target hemoglobin level should be defined on an individual basis, taking into account gender, age, ethnicity, activity, and comorbid conditions [3]
Intravenous iron sucrose was prescribed if ferritin was

Summary

Introduction

Anemia is a common complication of chronic kidney disease (CKD). The introduction of erythropoiesis-stimulating agents (ESA) has led to a dramatic reduction in blood transfusion requirements and has been associated with improved quality of life [1, 2]. The optimal target hemoglobin concentration in CKD remains a matter of considerable uncertainty, the European Best Practice Guidelines (EBPG) recommended that the target hemoglobin level should be defined on an individual basis, taking into account gender, age, ethnicity, activity, and comorbid conditions [3]. Fluctuation in hemoglobin levels, known as hemoglobin variability during treatment with ESA, is a well-documented phenomenon [4]. Lacson Jr. et al [6] reported that few patients maintained hemoglobin in the target range in a study that measured variability in patients with CKD. Ebben et al measured hemoglobin levels in a large cohort of patients for 6 months and found that only a minority of patients (6.5%) had stable hemoglobin levels over the study period with nearly 90% exhibiting some pattern of hemoglobin fluctuation [7]

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