Assesment of hemoglobi̇n stability and its impact on the risk of cardiovascular disease on chronic hemodialysis patients treated with erythropoietin

Assessment of Hemoglobin Stability and Its Impact on the Risk of Cardiovascular Disease on Chronic Hemodialysis Patients Treated with Erythropoietin Anemia is one of the most important problems that reduce the quality of life for end-stage renal disease patients undergoing hemodialysis. Erythropoietin stimulating agents (ESAs) are used for treatment of anemia in these patients. Although target Hb value is 11-12 g/dl in patients with chronic kidney disease, these values show fluctuations in the majority of patients. It has been proposed that these fluctuations increase mortality and cause cardiovascular structural changes. In this study we investigated the effect of fluctuations of hemoglobin for the development of cardiovascular risk in chronic hemodialysis patients under treatment of ESA. 181 patients' hemoglobin values were examined in the last 12 months. Target hemoglobin level was accepted as 11-12 g/dl. Patients were divided into 6 groups according to the level of hemoglobin as; persistently low, low-normal, target, high-normal, low-high, and persistently high. According to the variability in hemoglobin levels groups were compared in terms of the risk of cardiovascular diseases, frequency of hospitalizations and mortality, and demographics, laboratory data, and treatments used. A total of 181 patients were classified according to Hb levels. 22 patients (12,2%) were in persistently low, 72 were (39.8%) in low-normal, 10 were (5.5%) in normal-high, and 77 were (42.5%) in low-high Hb group. During the 12-month follow-up, there were no patients in target and high Hb group. Groups are distributed uniformly in terms of diabetes, hypertension, coronary artery disease, and in terms of other demographic characteristics. There was no difference in terms of mortality and cardiovascular disease development. Only in persistently low Hb group, the ESA doses and the number of blood transfusion were significantly higher than the other groups. In this study, high rates of anemia and hemoglobin variability has been shown in chronic hemodialysis (HD) patients. But the potential adverse consequences, such as the development of cardiovascular diseases and mortality were not statistically related to Hb variability. To determine the relationship between hemoglobin variability and cardiovascular risk factors, prospective studies are needed in the larger HD population. Key Words: Hemodialysis, anemia, hemoglobin variability, cardiovascular disease.