Time-averaged Concentration Hemoglobin and Erythropoietin Requirement According to Hemoglobin of Different Session of HD of the Week / 대한신장학회지

ABSTRACT

PURPOSE: The time average hemoglobin concentration (Hb-Tac) is more likely to represent hemodialysis (HD) patients' true hemoglobin due to variable hemoglobin concentration. This study was performed to evaluate the effect of erythropoietin adjustment on the Hb-Tac according to the Hb of different hemodialysis days. METHODS: A controlled, randomized, cross-over study, where 20 stable hemodialysis patients (7 males, 13 females, mean age 57.8+/-3.0 year, mean HD duration 973+/-707 days) acted as their own controls. EPO adjustment was performed by protocol and according to preHD Hb of the first HD session (group A) or the second HD session (group B) in cross over for each 8 weeks. Serial Hb-tac were calculated by equation [mid week preHD Hb+[midweek pre HT [midweek preHD Hb+(midweek postHD Hb-preHD Hb)/3] every two weeks during the entire study periods. Their iron status were monitored and maintained adequately as K/DOQI guidelines. RESULTS: There was no significant difference in clinical parameters except age during the entire study period. Mean hemoglobin at randomization and after 8, 16 weeks were 10.0+/-0.60, 10.10+/-1.19, 10.1+/-1.03, respectively, in group A compared with 9.93+/-0.62, 9.72+/-1.00, 10.3+/-1.12 g/dL in group B. Mean weekly epoetin alfa dosage at randomization and after 8, 16 weeks were 107.2+/-74.7, 123.2+/-43.1, 123.0+/-85.0 IU/kg/week, respectively in group A compared with 95.4+/-94.7, 107.4+/-60.7, 125.5+/-85.0 IU/kg/week in group B. There were no significant differences in Hb-tac and EPO dosage. Addition of antihypertensive occurred in three patients during EPO adjustment to preHD Hb of the first session. CONCLUSION: EPO dose adjustment according to the different day preHD Hb does not affect the Hb-tac and total EPO.