Associations between hemoglobin variability and hospitalization/mortality in maintenance hemodialysis patients

Abstract

【Aim】Our study aimed to examine the variability in hemoglobin (Hb) levels in Japanese hemodialysis (HD) patients to identify predictors of Hb variability and evaluate the associations between Hb variability and prognostic parameters, such as mortality at 30 months.【Patients and Methods】In this retrospective cohort study of 613 patients, Hb variability was determined using 6 months of data for the first half of 2010. Hb variability was assessed based on the residual standard deviation (Hb-RSD). We evaluated the associations between Hb variability and the risk of hospitalization or mortality in the 30-month period up to December 2012.【Results】Hb-RSD was predicted by the use of iron agents, high ferritin levels, and hospitalization in the exposure period according to multiple logistic regression analysis. The subjects were divided into high and low Hb-RSD groups according to the median Hb-RSD, and the high Hb-RSD group was at higher risk of hospitalization and had a lower survival rate than the low Hb-RSD group (Kaplan-Meier analysis and the log-rank test). Hb-RSD was found to be associated with the risk of all-cause mortality during 30 months' follow-up (Cox proportional hazard model analysis, hazard ratio: 2.54, 95% confidence interval; 1.06-6.06, p=0.036).【Conclusion】Hb-RSD independently predicts mortality over a 30-month period. Hb-RSD might be a predictor of the risk of mortality in HD patients.