Haemoglobin fluctuations in patients on haemodialysis treated with ESAs: clinical observations from two centres

The purpose of this analysis was to quantify haemoglobin (Hb) variability in patients receiving haemodialysis (HD) and erythropoiesis-stimulating agent (ESA) treatment from data independently collected in two different geographical settings. STUDY DESIGN, SETTINGS AND PATIENTS: Two studies retrospectively reviewed patients undergoing HD and stable ESA treatment at centres in Australia and the UK (56 and 154 patients, respectively). Monthly Hb values were obtained over a 12-month period. The frequency, duration, amplitude and direction of Hb fluctuations (Hb outside the range 11-12 g/dl in the Australian data-set and 11-12.5 g/dl in the UK data-set) were evaluated.

The overall mean Hb level was 11.27 and 11.71 g/dl in the Australian and UK data-set, respectively. All patients experienced > or =1 Hb fluctuation and 68-73% had > or =3 fluctuations over the study period. Upward and downward Hb fluctuations occurred with similar frequency and were of similar amplitude. Fluctuations of more extreme amplitude (high amplitude fluctuations) were more common than fluctuations of lesser amplitude. The total duration of time spent outside the Hb range (mean +/- standard deviation) was 8.6 +/- 2.5 and 7.4 +/- 2.5 months in the Australian and UK data-set, respectively. The total duration with Hb <11 g/dl was 3.7 +/- 3.0 and 3.7 +/- 2.7 months, respectively. Most patients (95%) required ESA dose adjustment; the median number of dose adjustments per patient was 2 (range 0-5).

Despite the study limitations of retrospectivity and its cross-sectional nature, the reported observations that Hb fluctuations outside target ranges occur frequently in patients on HD receiving ESAs are clearly confirmed and were strikingly similar in the two different geographical locations.