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Time-averaged hemoglobin values, not hemoglobin cycling, have an impact on outcomes in pediatric dialysis patients

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Abstract

Background

During erythropoietin-stimulating agent (ESA) treatment, hemoglobin (Hb) levels usually fluctuate; this phenomenon is known as “Hb cycling (HC).” In this study, we aimed to evaluate the predictors of HC and its impact on left ventricular hypertrophy (LVH) as a patient-important outcome parameter in pediatric dialysis patients.

Methods

Records of patients followed up in nine pediatric nephrology centers between 2008 and 2013 were reviewed. 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 frequent cycling (FC) (> 3 fluctuation) as well as three groups based on T-A-Hb levels: < 10, 10–11, and > 11 g/dL.

Results

Two hundred forty-five dialysis (160 peritoneal dialysis (PD) and 85 hemodialysis (HD)) patients aged 12.3 ± 5.1 (range 0.5–21) years were enrolled in this study. Fifty-two percent of the patients had RC, 45% had FC, and only 3% had no cycling. There were no differences between HC groups with respect to age, dialysis modality, having anemia, hospitalization rate, residual urine volume, and mortality. Although left ventricular mass index (LVMI) tended to be higher in RC than FC group (65 ± 37 vs 52 ± 23 g/m2.7, p = 0.056), prevalence of LVH was not different between the groups (p = 0.920). In regression analysis, FC was not a risk factor for LVH, but low T-A Hb level (< 10 g/dL) was a significant risk for LVH (OR = 0.414, 95% CI 0.177–0.966, p = 0.04). The target Hb levels were more often achieved in PD patients, and the number of deaths was significantly lower in non-anemic patients (Hb level > 11 g/dL).

Conclusion

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.

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Author information

Authors and Affiliations

  1. Department of Pediatric Nephrology, School of Medicine, Gazi University, Ankara, Turkey

    Sevcan A. Bakkaloğlu, Yaşar Kandur, Meltem Akcaboy & Yeşim Özdemir Atikel

  2. Department of Pediatric Nephrology, Dr. Behçet Uz Children’s Hospital, Izmir, Turkey

    Erkin Serdaroğlu

  3. Department of Pediatric Nephrology, School of Medicine, Baskent University, Adana, Turkey

    Aytül Noyan & Gönül Parmaksız

  4. Department of Pediatric Nephrology, School of Medicine, Cukurova University, Adana, Turkey

    Aysun Karabay Bayazıt & Bahriye Atmış

  5. Department of Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey

    Mehmet Taşdemir & Lale Sever

  6. Department of Pediatric Nephrology, Dr. Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey

    Sare Gülfem Özlü

  7. Department of Pediatric Nephrology, Şişli Etfal Training and Research Hospital, Istanbul, Turkey

    Gül Özçelik

  8. Department of Pediatric Nehprology, School of Medicine, Erciyes University, Kayseri, Turkey

    İsmail Dursun

  9. Department of Pediatric Nephrology, Tepecik Training and Research Hospital, Izmir, Turkey

    Caner Alparslan

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  1. Sevcan A. Bakkaloğlu
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Corresponding author

Correspondence to Sevcan A. Bakkaloğlu.

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All human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. All persons gave their informed consent prior to their inclusion in the study.

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The authors declare that they have no conflict of interest.

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Bakkaloğlu, S.A., Kandur, Y., Serdaroğlu, E. et al. Time-averaged hemoglobin values, not hemoglobin cycling, have an impact on outcomes in pediatric dialysis patients. Pediatr Nephrol 33, 2143–2150 (2018). https://doi.org/10.1007/s00467-018-4013-4

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  • DOI: https://doi.org/10.1007/s00467-018-4013-4

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