Link between pre-dialysis hemoglobin variability and later risk of death


Dr Ramesh Hotchandani    15 January 2018

Hemoglobin variability (Hb-var) has been found to have an association with increased mortality both in non-dialysis dependent chronic kidney disease (NDD-CKD) and end-stage renal disease (ESRD) patients. A study published in the American Journal of Nephrology evaluated 11,872 veterans from October 2007 to September 2011 who transitioned from chronic kidney disease to end-stage renal disease (ESRD). Investigators assessed patients’ history of hemoglobin variability (Hb-var) 6 months prior to starting dialysis and recorded three Hb values during the time period. It was noted that higher prelude Hb-var was associated with use of iron and antiplatelet agents, tunneled dialysis catheter use, higher levels of baseline Hb, change in Hb, eGFR, and serum ferritin. Multivariable adjustment revealed that higher prelude Hb-var was associated with higher post-ESRD all-cause and infection-related mortality, but not cardiovascular mortality. Therefore, high pre-ESRD Hb-var was found to be linked with higher mortality, especially from infectious causes.

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