Haemoglobin variability in haemodialysis patients

Objective: Anemia is an important factor affecting mortality and morbidity among haemodialysis (HD) patients. In recent years Hb variability which is seen concomittantly with the anemia treatment process has been thought to have an influence on this effect.The implementation of social security refunds for eritropoesis stimulating agent (ESA) treatment, which is one of the main factors of Hb variability, vary in our country, which makes Hb values fluctuate. In this study; our objective is to determine haemoglobin variability of the patients who are receiving hemodialysis treatment.Materials and Methods: Among 473 patients who are receiving HD treatment in three private dialysis center and have a 12 month regular registry, 1368 Hb value of 114 of them were analysed retrospectively. Hb values are classified as high >12 gr/dl, target 11-12 gr/dl and low <11gr/dl. Subgroups are as follows ; high amplitude fluctuation, high , high Hb low amplitude fluctuation , target , low hemoglobin low amplitude fluctuation and low . ESA types were equaled (EPO?,ß =Darbepoetin*200) and their doses were evaluated.Results: HA fluctuation was observed in 50 (43,9%) patients . One patient (0,9%) had constant high Hb values. 14 (12,3%) had low amplitude fluctuations although they had high Hb values. 45 (39,5%) had low amplitude fluctuations despite having low Hb values. Two patients (1,8%) had constant low Hb values. Only two (1,8%) of all(114) had constant target values. The average EPO dose of 12 month period was recorded as (n=94) 15817± 10023,7 IU (min 4400 IU - max 75181 IU). Average ESA dose adjustment was six times a year. Significant relationship was found between overall fluctuations and ESA use and dose adjustment (p<0.05).Conclusion: In our study; Hb values of HD patients showed a great deal of diversity. According to the data in literature; inappropriate use of ESA?s seems to be the most important cause of Hb fluctuation. In our country; on account of the refund conditions, we agree that the use of ESA plays an important role on the aforementioned variability. Furthermore, we hold the belief that ESA implementation policy can be reconstituted by prospective studies with larger number of patients.Key Words: Haemodialysis, Anemia, Haemoglobin Variability, Eritropoesis Stimulating Agent