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Difference between true functional haemoglobin and pre-dialysis haemoglobin is associated with plasma volume variation: a multicentre study

  • Nephrology - Original Paper
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Abstract

Purpose

Due to the well-known intradialytic haemoglobin (Hb) change, it has been suggested that true functional Hb differs from pre-dialysis Hb. However, mechanisms of this change are not understood properly. We aimed at studying the role of plasma volume variation.

Methods

This is a multicentre study with two consecutive phases. First, true functional Hb was predicted by Krisper’s formula that estimates time-averaged haemoglobin concentration (TAC-Hb) and by the average (Avg-Hb) of Pre-Hb and Post-Hb (n = 346). Erythropoiesis-stimulating agent (ESA) doses were estimated according to the FDA instructions. Second, we investigated the correlations between Hb changes (ΔHb), body weight loss (ΔBW) and relative plasma volume changes (%ΔPV) in subjects with a weight gain higher than 1 kg (n = 208).

Results

First: Avg-Hb and TAC-Hb were similar to each other and higher than midweek Pre-Hb (p < 0. 002). Odds of having an Hb change >1 g/dL were 0.415. Odds were similar in both women and men [odds ratio (OR) 0.923; 95 % confidence interval (CI) 0.591–1.441]. If ESA doses were estimated by TAC-Hb or Avg-Hb instead of Pre-Hb, they should be lower in 40 % of the 346 patients. Second: Mean %ΔPV was −12.1 % (95 % CI −10.72/−13.48), and mean ΔHb was 1.1 g/dL (95 % CI 0.97/1.25). Correlation between ΔHb and %ΔPV was −0.92 (r 2 0.84) whereas that of ΔHb/ΔBW was just −0.45 (r 2 0.21; p < 0.000). Prevalence of ΔHb >1 g/dL was independent of ΔBW from 1.4 to 6.3 kg. By contrast, prevalence of ΔHb >1 g/dL in %ΔPV quartiles was clearly linear: 0, 52, 90 and 100 %, respectively.

Conclusions

Plasma volume variations play a major role in intradialytic Hb change. True functional Hb should be estimated in all patients with a weight gain higher than 1 kg.

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Conflict of interest

All authors state that they have no conflict of interests.

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Authors and Affiliations

  1. Dialisis Madariaga, Avenida Buenos Aires y Calle 21, 7163, General Madariaga, Provincia de Buenos Aires, Argentina

    Esteban Siga

  2. Centro NefroUrologico Trenque Lauquen, Provincia de Buenos Aires, Argentina

    Miguel Fernandez

  3. Dialisis Olavarria, Provincia de Buenos Aires, Argentina

    Mario Galarza

  4. Dialisis Tandil, Provincia de Buenos Aires, Argentina

    Vito Mesina

  5. Dialisis Azul, Provincia de Buenos Aires, Argentina

    Hugo De Palma

  6. Dialisis 25 De Mayo, Mar Del Plata, Provincia de Buenos Aires, Argentina

    Raul Coste

Authors
  1. Esteban Siga
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  2. Miguel Fernandez
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  3. Mario Galarza
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  4. Vito Mesina
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  5. Hugo De Palma
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  6. Raul Coste
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Correspondence to Esteban Siga.

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Siga, E., Fernandez, M., Galarza, M. et al. Difference between true functional haemoglobin and pre-dialysis haemoglobin is associated with plasma volume variation: a multicentre study. Int Urol Nephrol 46, 2379–2384 (2014). https://doi.org/10.1007/s11255-014-0774-2

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  • DOI: https://doi.org/10.1007/s11255-014-0774-2

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