The aim of our study is to assess the hemoglobin variability among the erythropoetin treated hemodialysis patients.
The objectives are as follows.
1. To describe the hemoglobin variability
2. To compare the hemoglobin variability between the patients with and without blood transfusions
3. To identify the factors and their associations with the hemoglobin variability
Any suggestions about how to go about completing this study in a single center are appreciated.
Although there are several methods, as you know, to describe the hemoglobin variability I think, it is a simple, reasonable and persuasive method to calculate the standard deviation (SD) of hemoglobin values during a certain period ( annually or quarterly or monthly, whatever). As a matter of fact, DOPPS study adopted the SD method as an index of hemoglobin variability. DOPPS emphasized the strong correlation between hemoglobin SDs of facilities and their mortality rate.
It is also interesting to me that you are comparing the hemoglobin variability between the patient with and without blood transfusions. I would, to my personal opinion, like to anticipate the patients with blood transfusions may have less variability of hemoglobin values than the patients without transfusion. Sufficient iron supplementation is critically important to stabilize hemoglobin levels on erythropoietin treatment. In such a sense, the blood transfusion is considered to be an additional iron supplementation.
Concerning the factors that may influence hemoglobin variability, (1) frequency of the opportunities of checking hemoglobin values and adjusting the dosage of erythropoietin and (2) condition of body iron storages (serum ferritin and transferrin saturation) are supposed to be most important factors.
As a reference:
Shimamatsu K. Occasional assist by epoetin in addition to fixed dosage of darbepoetin on anemia management in hemodialysis patients. J Am Soc Nephrol 23: 427A, 2012 [Abstract]
Sir I have a collection of around 54 patients followed up over a period of 1 year. I have also compared the variability with the pt receiving emergency blood transfusion+ EPO VS Only EPO agent. Sir, does this variability hold any clinical significance?
Sir Pisoni et al. AJKD 2011 published a paper based on data from 25,417 patients DOPPS study found an increased relative risk of 8% per half gram increased the standard deviation of the mean of hemoglobin and a standard deviation of 1.70 increased the mortality risk by 20 %.
The lower variability of hemoglobins values correspond to lower values of the standard deviation of the mean.The typical high standard desvicación Hemoglobin is due to higher comorbidity and higher rate of patients hiporesponsives to EPO.
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