The prevalence and risk factors of chronic kidney disease among type 2 diabetes mellitus follow-up patients at Debre Berhan Referral Hospital, Central Ethiopia

Abstract

Introduction: Hemoglobin (Hb) variability occurs frequently in hemodialysis (HD) patients during erythropoietin (EPO) therapy. Guidelines define a narrow target range for anemia treatment in these patients that is difficult to adhere to in practice. Our aim was to evaluate whether the Hb variability in HD patients is higher compared to healthy subjects and patients with chronic kidney disease (CKD) stage I or II. Methods: Monthly blood samples were assessed prospectively in 100 healthy subjects and 57 patients with CKD stage I or II and retrospectively in 74 HD patients without changes in EPO or iron dose for six months. Variability was calculated and compared between the different groups. Results: Hb variability was significantly higher in HD patients compared to the other groups, corresponding to the results of previous studies. There were no significant differences between healthy subjects and patients with CKD stage I or II in terms of standard deviation (SD), residual SD, Fluctuations across the threshold, Hb cycling, and mean absolute change of Hb every 30 days (p > 0,05), but a significant difference compared to HD patients (p < 0,05). There were no significant differences between the groups in time in target and area under the curve (AUC) (p > 0,05). Conclusion: Hb variability is a common phenomenon in all groups independently of the method used for assessment and even without EPO therapy. The target range is hardly attainable for HD patients and should be reconsidered in the future to avoid unsettling both the patients and the staff.