SUN-283 MACROCYTOSIS: CAN IT PREDICT MORTALITY ON HEMODIALYSIS PATIENTS?

Abstract

Anemia is a commun consequence of end stage renal disease. It’s typically normocytic and normochromic. But macrocytosis is not rare in hemodialysis patients. However, it’s significance and association to mortality is still unknown. We conducted a single –centre prospective cohort study of 70 stable chronic hemodialysis patients followed for 24 months. Macrocytosis was defined as a mean corposcular volume(MCV)>97 fl. Patients was divided into 2 groups:with macrocytosis(G1) and without macrocytosis(G2). Three measurements of MCV were repeated monthly for three months to avoid laboratory error associated with single measurements. Follow up began from the date of last blood work and patients were prospectively followed for 2 years. We collected 70 patients undergoing chronic hemodialysis since 3 months at least with anemia. Among them,29 (40%) have macrocytic anemia. We divided our population into 2 groups:group1 (G1 :29 patients) included patients with macrocytic anemia and group2 (G2 :41 patients ) without macrocytosis. It was noted that the G1 was older than the G2 with a mean age respectively of 54 and 48 years with a significant difference (p < 0.05). Similarly, the association with neoplasia was more frequent in G1 with a significant difference (p = 0.01). The mean Hb was 9.8 g / dl and 9.6 g/dl respectively in G1 and G2 with a significant difference. Hypoalbuminemia(<40g / l) was more common in G1 with a significant difference(p = 0.016). Moreover, no significant difference was found between the two groups concerning the dose of erythropoetin, the incidence of diabetes, hypertension and hypothyroidism. In terms of prognosis, the charlson comorbidity index was significantly higher in G1(p = 0.01) with higher mortality(28%). In G1, the average rate of the MCV was 100.9fl[97.66-107], that for the three measurements of the MCV was on average 101.38%, 100.64% and 100.73% respectively.25% [8] patients had a MCV greater than 102fl.MCV> 102 fl was associated with a higher Charlson-Age comorbidity index(CACI) (p = 0.01) and higher mortality(p = 0.025). Among G1 patients,9% (3) have B12 vitamin deficiency and 11% (4) have folate deficiency, both have a combined deficiency in B12 and B9 vitamin. However, the cause of macrocytosis remains unexplained in the others. Macrocytosis may be associated with mortality in stable chronic hemodialysis patients. Future studies will need to be conducted to confirm this findings.