Haeoglobin Variability In Haemodialysis Patients Impact On Mortality And Morbidity

Abstract

Nephrologists and other practitioners face a significant dilemma with regard to the management of anemia in patients undergoing long – term hemodialysis . Fluctuations in Hemoglobn levels ( Hemoglobin cycling ) , may have a negative effect on patient survival and can frustrate the clinician who is trying to maintain a stable Hemoglobin value . 500 prevalent hemodialysis patients were enrolled in the sudy . They were divided into 6 groups according to stable Hemoglobin levels and Hb variability range throughout the six months of the study : we found 12.6 % of patients in Low Hb Group 1 ( stable Hb levels below 11 g / dl ) ; 5.8 % in Target range Hb Group 2 ( stable Hb levels in the range of 11 – 12 g / dl ) ; 3 % in High Hb Group 3 ( stable Hb levels above 13 g / dl ) ; 41.6 % in LAL fluctuation Group 4 ( low amplitude fluctuation between low and target range levels ) ; 13.4 % in LAH fluctuation Group 5 ( low amplitude fluctuation between target range and high levels ) ; 23.6 % in HA fluctuation Group 6 ( high amplitude fluctuation between low and high levels ) . We had no mortality cases among our patients . Hospitalization rate was 40 % in High Hb Group 3 ; 28.6 % in Low Hb Group 1 ; 24.6 % in HA fluctuation Group 6 ; 22.4 % in LAH fluctuation Group 5 ; 13 % in LAL fluctuation Group 4 ; and 10.3 % in Target range Hb Group 2 . High Hb Group 3 had a significantly higher risk for hospitalization than Target range Hb Group 2 ( OR = 5.77 , 95 % CI = 1.19 – 28.04 , P = 0.05 ) . Age and female gender were two risk factors for hospitalization in some groups of the study ( P < 0.05 ) .within different groups , most cases having hospitalization events showed a drop in their mean Hemoglobin levels with no specific pattern and a minority of hospitalized cases showed an increase in their Hb levels .