ESPN 50th Annual Meeting

ESPN 2017


 
Impact of hemoglobin variability on outcome parameters in pediatric dialysis patients
SEVCAN A. BAKKALOGLU 1 YASAR KANDUR 1 ERKIN SERDAROGLU 2 AYTUL NOYAN 3 AYSUN KARABAY BAYAZIT 4 LALE SEVER 5 SARE G. OZLU 6 GUL OZCELIK 7 ISMAIL DURSUN 8 CANER ALPARSLAN 9

1- GAZI UNIVERSITY, DEPARTMENT OF PEDIATRIC NEPHROLOGY, ANKARA
2- DR. BEHÇET UZ CHILDRENS HOSPITAL, DEPARTMENT OF PEDIATRIC NEHPROLOGY, IZMIR
3- BASKENT UNIVERSITY, DEPARTMENT OF PEDIATRIC NEPHROLOGY, ADANA
4- CUKUROVA UNIVERSITY, DEPARTMENT OF PEDIATRIC NEPHROLOGY, ADANA
5- ISTANBUL UNIVERSITY, CERRAPHASA MEDICAL SCHOOL, DEPARTMENT OF PEDIATRIC NEHPROLOGY, ISTANBUL
6- DR.SAMI ULUS MATERNITY AND CHILDREN RESEARCH AND TRAINING HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY, ANKARA
7- ŞIŞLI ETFAL TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY, ISTANBUL
8- ERCIYES UNIVERSITY, DEPARTMENT OF PEDIATRIC NEPHROLOGY, KAYSERI
9- TEPECIK TRAINING AND RESEARCH HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY, IZMIR
 
Introduction:

 During treatment with ESA, level of hemoglobin (Hb) usually fluctuates; this phenomenon is known as "hemoglobin cycling (HC)" and there is some debate about whether or not this may lead to increased morbidity/mortality in adults. It was aimed to evaluate the impact of HC on patient-important outcome parameters including left ventricular hypertrophy (LVH) and inflammation in pediatric dialysis patients.

Material and methods:

Records of patients followed-up in nine centers (2008-2013) were retrospectively reviewed. Biochemical parameters, complete blood count, CRP, echocardiographic data, monthly-Hb and albumin levels for the last one year were collected, where available. More than 1 g/dL decrease or increase in Hb level was considered as HC. Patients were divided into two groups according to 12-month Hb-trajectory as rare cycling (RC)(≤ 3) and freuquent cycling (FC)(≥4 fluctuation) as well as three groups based on time-averaged-Hb levels; <10, 10-11 and >11g/dl.

Results:

245 dialysis patients aged 12.3±5.1 (range: 0.5–21) years were enrolled in this study. 50% of the patients had 1-3 cycling, 82% had 1-5, only 3% had no cycling. There were no differences between HC groups with respect to age, primary renal disease, dialysis modality, having anemia and hospitalization rate, while RC patients had higher urine output (p<0.01) and higher CRP levels (p<0.001). Echocardiographic data were available in 137 patients. Although LV mass index (LVMI) was higher in RC than FC group (65±37 vs 52±23g/m2.7, p=0.056), prevalence of LVH was not different between groups. Time-averaged-Hb levels were inversely correlated with ESA requirement (r=-0.497), mean arterial pressure (r=-0.213), LVMI (r=-0.471) and CRP (r=-0.443), but positively with urine output (r=0.296) and albumin levels (r=0.275). Patients with time-averaged-Hb levels<10 g/dl had an increased risk of LVH and inflammation. 

Conclusions:

Hb cycling is common among dialysis patients.Severity of anemia rather than its cycling has more significant impact on the prevalence of LVH and on inflammatory state.