Abstract
The concept of hemoglobin cycling (Hb cycling) in the treatment of renal anemia with erythropoiesis-stimulating agent (ESA) has recerved considerable attention. Hb cycling is a non-physiological periodic variability in Hb levels, which may be associated with hospitalization and cardiovascular complications, determining the survival prognosis of hemodialysis patients. In this context, inhibition of Hb variability appears to be important to improving patient prognosis. We analyzed the Hb variability induced by the conventional rHuEPO prescription regimen in 230 stable hemodialysis patients at our hospital (140 males and 90 females) and showed that the mean Hb level was low, and that variability comprised a high-risk pattern affecting a high percentage of patients (9.68±0.97 g/dL, Low : 33.5%, LAL : 51.7%). We, therefore, changed these patients to a new regimen and followed the patients for 1 year. The mean Hb level rose to the target range recommended by the JSDT guidelines, and the rate of patients showing a decrease in the high-risk Hb variability pattern (add the numbers equivalent to the pretreatment value of 10.35±1.05 g/dL, Low : 11.8%, LAL : 56.5%). These findings suggest that the newly-employed rHuEPO regimen in our hospital may be a better administration method of rHuEPO than that of the conventional one, and that this new method can be applicable to patients with clinically overt Hb variability.
