[Hemoglobin levels in hemodialysis patients treated with epoetin: a Brazilian experience]

Rev Assoc Med Bras (1992). 2010 Mar-Apr;56(2):209-13. doi: 10.1590/s0104-42302010000200021.
[Article in Portuguese]

Abstract

Objective: Correction of anemia using epoetin decreases morbidity and increases survival and quality of life in end-stage renal disease. Maintaining hemoglobin levels within the range proposed by guidelines has become a major challenge, with hemoglobin cycling affecting more than 90% of patients undergoing hemodialysis. The variability of hemoglobin levels over time was assessed in our patients.

Methods: Data were retrospectively collected on 249 patients undergoing hemodialysis over a 3-year period at seven centers in Brazil. Hemoglobin was measured at least monthly, and target levels were those between 10.5 g/dL and 12.5 g/dL. Patients were grouped into six categories of variability consistently low (<10.5 g/dL), consistently target range (10.5 to 12.5 g/dL), consistently high (>12.5 g/dL), low amplitude fluctuation with low hemoglobin levels, low amplitude fluctuation with high hemoglobin levels and high amplitude fluctuation. None of the patients maintained stable hemoglobin levels for the entire 36-month period.

Results: The mean monthly proportion of patients that had hemoglobin levels within the target range was 50% (range, 42% to 61%). Mean levels above the target (30%) were more frequent than those below it (20%). During 6, 12, and 36 months, proportions of patients with consistently low levels of hemoglobin decreased from 3.6% to 0%, from 31.7% to 2.8% for those with consistently high, from 7.6% to 0% for those with low amplitude fluctuation with low hemoglobin levels and from 41.3% to 8.3% for those with low amplitude fluctuation with high hemoglobin levels. However, the proportions of patients with high amplitude fluctuation increased from 21.5% to 88.9%.

Conclusion: Maintaining hemoglobin levels within the target range is difficult, especially for longer periods of time. Missing the target seems more often due to levels above it, but high-amplitude fluctuations eventually occur in the majority of patients.

Publication types

  • English Abstract

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anemia / diagnosis
  • Anemia / drug therapy*
  • Anemia / etiology
  • Epoetin Alfa
  • Erythropoietin / therapeutic use*
  • Female
  • Hematinics / therapeutic use*
  • Hemoglobins / analysis*
  • Humans
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Recombinant Proteins
  • Reference Values
  • Renal Dialysis
  • Retrospective Studies
  • Young Adult

Substances

  • Hematinics
  • Hemoglobins
  • Recombinant Proteins
  • Erythropoietin
  • Epoetin Alfa