Factors Influencing Hemoglobin Variability and Its Association with Mortality in Hemodialysis Patients

Purpose. We aimed to investigate the factors infuencing hemoglobin variability with infammatory and nutritional parameters and its associations with all-cause mortality among hemodialysis patients. Methods. One hundred and sixty-nine patients during the entire 12 months were enrolled into the study. Fasting plasma glucose, creatinine, calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH), C-reactive protein (CRP), serum iron, serum iron-binding capacity, and transferrin saturation were analyzed. We defned six groups: low, target range, high, low-amplitude fuctuation with low hemoglobin levels, low-amplitude fuctuation with high hemoglobin levels, and high-amplitude fuctuation. Body mass index (BMI), malnutrition-infammation score (MIS), and Charlson Comorbidity Index were evaluated. Results. Hemoglobin variability was signifcantly correlated with age, platelet count, and number of hospitalization instances and inversely correlated with erythropoietin dose per body surface area. Te coefcient of variation of hemoglobin showed a correlation with MIS and ferritin. Te absolute level of hemoglobin showed a negative correlation between PTH, CRP, MIS, number of hospitalization instances and a positive correlation with albumin and BMI. High, low, and target-range groups showed survival advantage compared to the other three groups. In regression analysis, age, CRP levels, MIS, and BMI were the predictors of mortality. Conclusion. Infammation and duration of anemia were the major predictors of hemoglobin variability. High-amplitude fuctuation predicts high mortality; on the contrary low-amplitude fuctuations is related to better survival. MIS was independently associated with mortality. Tis trial is registered with NCT03454906.