Variability in Hemoglobin Levels and the Factors Associated with Mortality in Hemodialysis Patients: A 78-Month Follow-Up Study

Natalino Salgado Filho, Joyce Santos Lages, Dyego José de Araújo Brito, Elton John Freitas Santos, Alcione Miranda dos Santos, Francival Leite de Souza, Vinícius Giuliano Gonçalves Mendes, Giselle Andrade dos Santos Silva, Erika Cristina Ribeiro de Lima Carneiro, Monique Pereira Rêgo Muniz, Gyl Eanes Barros Silva and Ricardo de Castro Cintra Sesso
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Natalino Salgado Filho: Renal Division, Federal University of Maranhão, São Luís 65020-070, Brazil
Joyce Santos Lages: Renal Division, Federal University of Maranhão, São Luís 65020-070, Brazil
Dyego José de Araújo Brito: Renal Division, Federal University of Maranhão, São Luís 65020-070, Brazil
Elton John Freitas Santos: Renal Division, Federal University of Maranhão, São Luís 65020-070, Brazil
Alcione Miranda dos Santos: Renal Division, Federal University of Maranhão, São Luís 65020-070, Brazil
Francival Leite de Souza: Renal Division, Federal University of Maranhão, São Luís 65020-070, Brazil
Vinícius Giuliano Gonçalves Mendes: Renal Division, Federal University of Maranhão, São Luís 65020-070, Brazil
Giselle Andrade dos Santos Silva: Renal Division, Federal University of Maranhão, São Luís 65020-070, Brazil
Erika Cristina Ribeiro de Lima Carneiro: Renal Division, Federal University of Maranhão, São Luís 65020-070, Brazil
Monique Pereira Rêgo Muniz: Renal Division, Federal University of Maranhão, São Luís 65020-070, Brazil
Gyl Eanes Barros Silva: Renal Division, Federal University of Maranhão, São Luís 65020-070, Brazil
Ricardo de Castro Cintra Sesso: Discipline of Nephrology, Paulista School of Medicina, Federal University of São Paulo, São Paulo 04023-062, Brazil

IJERPH, 2021, vol. 18, issue 3, 1-11

Abstract: Some studies have described that when the hemoglobin levels of chronic kidney disease (CKD) patients change, especially in those taking erythropoiesis-stimulating agents (ESA), they are associated with unfavorable outcomes such as increased morbidity and mortality, mainly due to cardiovascular events. This prospective cohort study included patients with end-stage renal disease currently undergoing hemodialysis. The initial 6-month clinical evaluation provided data of the variability in hemoglobin, associated blood parameters, and the use of erythropoietin. Subsequently, the patients were followed up for 78 months to evaluate mortality-associated factors. In total, 133 patients completed the 6-month follow-up with a mean age of 47.1 (±13.2) years. The majority were women (51.9%). Six-month hemoglobin levels were as follows: always low (18.0%), intermediate/target (1.5%), always high (0.8%), low-amplitude fluctuation/Hb low ( n = 37; 27.8%), low-amplitude fluctuation/Hb high (13.53%), and high-amplitude fluctuation (38.6%), among end-stage renal disease patients. At the end of 78 months, 50 (37.6%) patients died; 70% of deaths were attributed to cardiovascular etiologies. A high variability was observed in hemoglobin levels, which was not associated with mortality. Among all the variables evaluated, age, erythropoietin dose, and transferrin saturation were associated with a higher mortality. Thus, this study suggests that greater attention to erythropoietin doses and transferrin saturation levels may improve the survival of dialysis patients.

Keywords: hemoglobin; erythropoiesis-stimulating agents; mortality; hemodialysis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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