Abstract
BackgroundMacrocytosis occurs in chronic hemodialysis (CHD) patients; however, its significance is unknown. The purpose of this study was to establish the prevalence and distribution of macrocytosis, to identify its clinical associations and to determine if macrocytosis is associated with mortality in stable, chronic hemodialysis patients.MethodsWe conducted a single-centre prospective cohort study of 150 stable, adult CHD patients followed for nine months. Macrocytosis was defined as a mean corpuscular volume (MCV) > 97 fl. We analyzed MCV as a continuous variable, in tertiles and using a cutoff point of 102 fl.ResultsThe mean MCV was 99.1 ± 6.4 fl, (range 66-120 fl). MCV was normally distributed. 92 (61%) of patients had an MCV > 97 fl and 45 (30%) > 102 fl. Patients were not B12 or folate deficient in those with available data and three patients with an MCV > 102 fl had hypothyroidism. In a logistic regression analysis, an MCV > 102 fl was associated with a higher Charlson-Age Comorbidity Index (CACI) and higher ratios of darbepoetin alfa to hemoglobin (Hb), [(weekly darbepoetin alfa dose in micrograms per kg body weight / Hb in g/L)*1000]. There were 23 deaths at nine months in this study. Unadjusted MCV > 102 fl was associated with mortality (HR 3.24, 95% CI 1.42-7.39, P = 0.005). Adjusting for the CACI, an MCV > 102 fl was still associated with mortality (HR 2.47, 95% CI 1.07-5.71, P = 0.035).ConclusionsMacrocytosis may be associated with mortality in stable, chronic hemodialysis patients. Future studies will need to be conducted to confirm this finding.
Highlights
Macrocytosis occurs in chronic hemodialysis (CHD) patients; its significance is unknown
Reticulocytes can be smaller than mature red cells [22], and no studies have addressed the relationship between Erythropoiesis stimulating agents (ESAs) and macrocytosis
thyroid stimulating hormone (TSH), serum B12 and RBC folate levels were available at baseline in 22 (49%), 21 (47%) and 28 (62%) patients with an mean corpuscular volume (MCV) > 102 fl
Summary
Macrocytosis occurs in chronic hemodialysis (CHD) patients; its significance is unknown. Several causes have been identified including iron deficiency [1], reduced production of erythropoietin [2], shortened red cell survival [3] and folate deficiency [4]. Erythropoiesis stimulating agents (ESAs) have been effective in treating the anemia of ESRD [5,6]. Despite their use, anemia may still occur and is associated with significant morbidity and mortality in dialysis patients [7,8]. Proposed causes of macrocytosis in dialysis patients include intravenous iron [15,17], megaloblastic anemia due to B12 and folate deficiency [4] or dialysis-induced changes in red cell volume [18,19]. Reticulocytes can be smaller than mature red cells [22], and no studies have addressed the relationship between ESAs and macrocytosis
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