Assessment of Hemoglobin Stability in Chronic Hemodialysis Patients Receiving Erythropoietin Therapy and the Effect of Hemoglobin Stability on Risk of Cardiovascular Disease

Abstract

Objective: Anemia is one of the most important factors that decrease the quality of life in patients with end-stage renal desease receiving hemodialysis treatment. In these patients, Erythropoietin stimulating agents (ESAs) are used in the treatment of anemia. Although the target hemoglobin (Hb) value in chronic renal failure is 11-12 gr/dL, it is suggested that hemoglobin values fluctuate between normal, high and low values in the great majority, leading to cardiovascular structural changes which increase mortality. In this study, we investigated the effect of anemia and hemoglobin fluctuations on mortality rate and the risk of cardiovascular disease in chronic hemodialysis patients who received ESA thearapy.

Materials and Methods: Hemoglobin values for 12 months of 181 patients were examined. The target Hb level was 11-12 gr/dL interval and the patients were divided into 6 groups according to the hemoglobin values; persistently low, low-normal, target, normal-high, low-high and persistently high. According to the variability in hemoglobin level, groups were compared in terms of demographic, laboratory characteristics, treatment, risk of cardiovascular disease, hospitalization and death frequency and causes.

Result: The total of 181 patients were classified according to Hb levels; 22 (12.2%) patients were persistently-low, 72 (39.8%) were low-normal, 10 (5.5%) were normal-high and 77 (42.5%) patients were low-high Hb group. During the 12 month fallow up, there were no patients in target and high Hb group. The groups were similar in terms of the presence of comorbid diseases such as diabetes, hypertension, coronary artery disease and other demographic characteristics, and there was no difference between groups in terms of cardiovascular disease development. ESA doses and blood transfusion counts and mortality rates were significantly higher in the persistently-low hemoglobin group compared to the other groups.

Conclusion: In our study, high rate of anemia and hemoglobin fluctuations were shown in chronic hemodialysis patients and anemia was associated with mortality. However, the possible association of these variables with cardiovascular diseases was not observed. Further studies are needed in the larger hemodialysis patient group to investigate the relationship between hemoglobin fluctuation and mortality and cardiovascular risk.