International Urology and Nephrology

, Volume 49, Issue 10, pp 1859–1866 | Cite as

The relation between hemoglobin variability and carotid intima-media thickness in chronic hemodialysis patients

  • Safa Ersen Ganidagli
  • Orcun Altunoren
  • Ertuğrul Erken
  • Ismet Onder Isık
  • Berivan Ganidagli
  • Necmi Eren
  • Yasemin Coskun Yavuz
  • Ozkan Gungor
Nephrology – Original Paper



Hemoglobin variability is a common problem among hemodialysis patients. We have previously demonstrated an association between Hb variability and left ventricular mass index. In this study, we investigated a possible relation between Hb variability and carotid intima-media thickness (CIMT).


Twelve-month hemoglobin (Hb) values of 135 patients on maintenance hemodialysis were examined retrospectively. The range of 11–12 gr/dl was accepted as normal according to the KDOQI guidelines. Hemoglobin levels were classified as: Hb < 11 gr/dl:Low, Hb = 11–12 gr/dl:Normal and Hb > 12 gr/dl:High. According to 12-month Hb trajectory, the patients were divided into three groups: low–normal (LN), normal–high (NH) and low–high (LH). The CIMT measurements were taken on common carotid arteries bilaterally, and the average of these measurements were taken. The groups were compared in terms of CIMT measurements, demographic and laboratory features.


The LN, NH and LH groups were similar in terms of age, gender, incidence of diabetes mellitus, hypertension and cardiovascular diseases. Duration of hemodialysis, hemodialysis adequacy, serum lipids and CaxP products were also similar among the groups. The mean CIMT value was 0.601 ± 0.107, 0.744 ± 0.139 and 0.604 ± 0.134 mm in the LN, LH and NH groups, respectively (p < 0.001). CIMT was significantly higher in LH than in the other two groups.


In our study, when the three groups with similar risk factors for atherosclerosis were examined, we found that the LH group with the highest hemoglobin variability has the highest CIMT. This study is the first study to demonstrate that Hb variability is associated with an increase in CIMT in HD patients.


Anemia Carotid intima-media thickness End-stage renal disease Hemodialysis Hemoglobin variability 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • Safa Ersen Ganidagli
    • 1
  • Orcun Altunoren
    • 2
  • Ertuğrul Erken
    • 2
  • Ismet Onder Isık
    • 3
  • Berivan Ganidagli
    • 1
  • Necmi Eren
    • 4
  • Yasemin Coskun Yavuz
    • 5
  • Ozkan Gungor
    • 2
  1. 1.Faculty of Medicine, Internal Medicine DepartmentKahramanmaras Sutcu Imam UniversityKahramanmaraşTurkey
  2. 2.Faculty of Medicine, Nephrology DepartmentKahramanmaras Sutcu Imam UniversityKahramanmaraşTurkey
  3. 3.FMC Kahramanmaras Dialysis Center, InternalistKahramanmaraşTurkey
  4. 4.Faculty of Medicine, Nephrology DepartmentKocaeli UniversityIzmitTurkey
  5. 5.Nephrology DepartmentErzurum Training and Research HospitalErzurumTurkey

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