Hemoglobin Variability in Patients with Chronic Kidney Disease in the Netherlands

Abstract

Purpose Hemoglobin cycling has been reported in hemodialysis patients treated with erythropoiesis-stimulating agents (ESA) and is associated with increased mortality. Information on hemoglobin cycling in Europe is limited. We investigated hemoglobin variability in the Netherlands. Hemodialysis and peritoneal dialysis patients were studied and pre-dialysis patients were enrolled. Methods This observational retrospective study was executed in a Dutch dialysis center. We studied 157 patients from 2005 to 2007: 56 hemodialysis, 12 peritoneal dialysis and 29 pre-dialysis patients, all treated with ESA; and 60 pre-dialysis patients without ESA. Patients were divided on the basis of their pattern of hemoglobin fluctuation around a range of 11–12 g/dL. In dialysis patients, the amount of time that hemoglobin remained within that range was calculated. For all patients, the magnitude of hemoglobin fluctuations was assessed (i.e. the difference between hemoglobin maximum and minimum) and data on ESA dose changes and hospitalizations were collected. Results None of the ESA treated patients had hemoglobin levels stable within the target range over a one-year period. Pre-dialysis patients without ESA also showed variable hemoglobin levels. A stepwise decrease in the magnitudes of hemoglobin fluctuation was observed in the hemodialysis patients, peritoneal dialysis patients, pre-dialysis patients using ESA, and the pre-dialysis patients without ESA, respectively. Conclusion In the Netherlands, hemoglobin variability is common in hemodialysis and peritoneal dialysis patients, but also in pre-dialysis patients. The results of this study warrant further research into the relationship between hemoglobin variability and clinical outcomes.

Hemoglobin Variability with Epoetin Beta and Continuous Erythropoietin Receptor Activator in Patients on Peritoneal Dialysis

“…Other published data on Hb stability in PD patients are scarce. One study included 12 patients, but grouped them for analysis with patients on HD (8). The only other available data come from a registry report that lacks detailed resolution of individual patient details (9).…”

Anemia Control in Kidney Transplant Recipients Using Once-Monthly Continuous Erythropoietin Receptor Activator: A Prospective, Observational Study

“…These have reported Hb levels within the 11-12 g/dL window at all three evaluation visits in 15.6% and 18.4% of patients, respectively. These findings should be interpreted against the background of a naturally high degree of Hb variability in patients with CKD [39, 40]. Indeed, it has been shown that the mean within-patient variability is greater than 1 g/dL in CKD patients receiving ESA therapy [40, 41].…”

Stable hemoglobin in hemodialysis patients: forest for the trees – a 12-week pilot observational study

“…Lacson and colleagues reported important fluctuations over time, with only 5% of ESRD patients in the target range during a 6-month period observation [20]. In another retrospective study, undertaken in the Netherlands, none of the 97 ESA-treated patients had Hb levels stable within the target range over a one-year period [21]. In our present study, we report stable levels of hemoglobin as a whole in the evaluable population, as well as in the cardiac and diabetic subgroups, during the whole study period.…”