Introduction:
Patients on chronic haemodialysis (HD) have significantly higher mortality rates than general population. Anemia is a common complication of uremia and a major contributor to morbidity and mortality of patients on HD. Currently we have several options for treating anemia in HD patients, with short-acting epoetin being the most common erythropoiesis-stimulating agent. The benefits of correcting anemia in HD patients are well known, but the perfect hemoglobin (Hgb) value is still undetermined. Guidelines recommend keeping Hgb in the range from 100 g/L to 115 g/L and avoiding extremes that could lead to the worsening of symptoms and potential unwanted cardiovascular events. It is a very demanding task in the real world setting.
Methods:
We have retrospectively collected the data from 60 patients on chronic HD in Dubrava University Hospital (18 female, 42 male patients). Hemoglobin values and weekly epoetin doses were measured (epoetin alpha or theta) on a monthly basis for a period of 10 to 15 months. The coefficient of variation was used to assess the oscillations of Hgb values and epoetin dose.
Results:
Hgb values varied from 74 g/L to 134 g/L with an average value of 106,5 g/L with a slight difference between male (107,3 g/L) and female (104,7 g/L) patients. 45 patients (75%) had the average Hgb value in the desired reference interval (slightly more female patients, 78%). The coefficient of variability of Hgb varied from 2,7% to 13,5% with an average value of 7,4%, without a significant difference between male (7,5%) and female (7,3%) patients. Weekly doses of epoetin varied from 0 international units (IU) to 16000 IU, with an average value of 4795 IU. The average epoetin dose was 4685 IU and 5070 IU for male and female patients respectively. The coefficient of variability for epoetin dose ranged from 0% to 172%, the mean value being 48% with a difference between male (52%) and female patients (40%).
Conclusions:
Maintaining Hgb levels in patients on chronic HD is an extremely difficult task, but it has multiple benefits. With short-acting epoetin, this task can be achieved for 75% patients during long periods with slight Hgb oscilations of 7,4%. But to achieve this stability of Hgb, we need higher oscillations of epoetin doses. Male patients had slightly better Hgb values than female patients and this was achieved with lower doses of epoetin, but with higher dose variations. By keeping patients` Hgb values within desired range we can improve their quality of life and significantly decrease cardiovascular risk.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.