Table of Contents Author Guidelines Submit a Manuscript
The Scientific World Journal
Volume 2018, Article ID 8065691, 7 pages
Clinical Study

Factors Influencing Hemoglobin Variability and Its Association with Mortality in Hemodialysis Patients

1Department of Nephrology, Ankara Training and Research Hospital, Ankara, Turkey
2Dr. Nafiz Korez State Hospital, Ankara, Turkey
3Department of Nephrology, Baskent University Faculty of Medicine, Ankara, Turkey
4Department of Nephrology, Baskent University Faculty of Medicine, Istanbul, Turkey

Correspondence should be addressed to Suleyman Karakose; moc.oohay@esokaraknamyelus

Received 6 October 2017; Revised 25 December 2017; Accepted 11 January 2018; Published 1 April 2018

Academic Editor: Allen R. Nissenson

Copyright © 2018 Zeynep Bal et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. We aimed to investigate the factors influencing hemoglobin variability with inflammatory and nutritional parameters and its associations with all-cause mortality among hemodialysis patients. Methods. One hundred and sixty-nine patients during the entire 12 months were enrolled into the study. Fasting plasma glucose, creatinine, calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH), C-reactive protein (CRP), serum iron, serum iron-binding capacity, and transferrin saturation were analyzed. We defined six groups: low, target range, high, low-amplitude fluctuation with low hemoglobin levels, low-amplitude fluctuation with high hemoglobin levels, and high-amplitude fluctuation. Body mass index (BMI), malnutrition-inflammation score (MIS), and Charlson Comorbidity Index were evaluated. Results. Hemoglobin variability was significantly correlated with age, platelet count, and number of hospitalization instances and inversely correlated with erythropoietin dose per body surface area. The coefficient of variation of hemoglobin showed a correlation with MIS and ferritin. The absolute level of hemoglobin showed a negative correlation between PTH, CRP, MIS, number of hospitalization instances and a positive correlation with albumin and BMI. High, low, and target-range groups showed survival advantage compared to the other three groups. In regression analysis, age, CRP levels, MIS, and BMI were the predictors of mortality. Conclusion. Inflammation and duration of anemia were the major predictors of hemoglobin variability. High-amplitude fluctuation predicts high mortality; on the contrary low-amplitude fluctuations is related to better survival. MIS was independently associated with mortality. This trial is registered with NCT03454906.