The relation between hemoglobin variability and carotid intima-media thickness in chronic hemodialysis patients
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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.
KeywordsAnemia 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.
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 was obtained from all individual participants included in the study.
- 1.Regidor DL, Kopple JD, Kovesdy CP, Kilpatrick RD, McAllister CJ, Aronovitz J, Greenland S, Kalantar-Zadeh K (2006) Associations between changes in hemoglobin and administered erythropoiesis-stimulating agent and survival in hemodialysis patients. J Am Soc Nephrol 17:1181–1191. doi: 10.1681/ASN.2005090997 CrossRefPubMedGoogle Scholar
- 3.Brunelli SM, Joffe MM, Israni RK, Yang W, Fishbane S, Berns JS, Harold I, Feldman HI (2008) Adjusted marginal structural analysis of the association between hemoglobin variability and mortality among chronic hemodialysis patients. Clin J Am Soc Nephrol 3:777–782. doi: 10.2215/CJN.04281007 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Boudville NC, Djurdjev O, Macdougall IC, de Francisco AL, Deray G, Besarab A, Stevens PE, Walker RG, Ureña P et al (2009) Hemoglobin variability in nondialysis chronic kidney disease: examining the association with mortality. Clin J Am Soc Nephrol 4:1176–1182. doi: 10.2215/CJN.04920908 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Altunoren O, Dogan E, Sayarlioglu H, Acar G, Yavuz YC, Aydın N, Sahin M, Akkoyun M, Isik IO, Altunoren Ö (2013) Effect of hemoglobin variability on mortality and some cardiovascular parameters in hemodialysis patients. Ren Fail 35(6):819–824. doi: 10.3109/0886022X.2013.801270 CrossRefPubMedGoogle Scholar
- 24.Davignon J, Ganz P (2004) Role of endothelial dysfunction in atherosclerosis. Circulation 109(23 Suppl 1):27–32Google Scholar
- 31.Abbasi MR, Abbaszadeh SH, Rokni-Yazdi H, Lessan-Pezeshki M, Khatami MR, Mahdavi-Mazdeh M, Ahmadi F, Seifi S, Gatmiri SM (2016) Carotid intima-media thickness as a marker of atherosclerosis in hemodialysis patients. Indian J Nephrol 26:97–101. doi: 10.4103/0971-4065.161544 CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Janda K, Krzanowski M, Gajda M, Dumnicka P, Fedak D, Lis GJ, Jaśkowski P, Pietrzycka A, Litwin JA, Sułowicz W (2015) Cardiovascular risk in chronic kidney disease patients: intima-media thickness predicts the incidence and severity of histologically assessed medial calcification in radial arteries. BMC Nephrol 16:78. doi: 10.1186/s12882-015-0067-8 CrossRefPubMedPubMedCentralGoogle Scholar
- 40.Patsalas S, Eleftheriadis T, Spaia S, Theodoroglou H, Panou E, Liakopoulos V, Antoniadi G, Passadakis P, Vayonas G, Kanakis E, Vargemezis V (2005) The value of computed tomography-derived coronary artery calcification score in coronary artery disease detection in asymptomatic hemodialysis patients. Ren Fail 27:683–688CrossRefPubMedGoogle Scholar