Hemoglobin variability does not predict mortality in european hemodialysis patients

Kai Uwe Eckardt, Joseph Kim, Florian Kronenberg, Pedro Aljama, Stefan D. Anker, Bernard Canaud, Bart Molemans, Peter Stenvinkel, Guntram Schernthaner, Elizabeth Ireland, Bruno Fouqueray, Iain C. Macdougall

Research output: Contribution to journalArticlepeer-review


Patients with CKD exhibit significant within-patient hemoglobin (Hb) level variability, especially with the use of erythropoiesis stimulating agents (ESAs) and iron. Analyses of dialysis cohorts in the United States produced conflicting results regarding the association of Hb variability with patient outcomes. Here, we determined Hb variability in 5037 European hemodialysis (HD) patients treated over 2 years to identify predictors of high variability and to evaluate its association with all-cause and cardiovascular disease (CVD) mortality. We assessed Hb variability with various methods using SD, residual SD, time-in-target (11.0 to 12.5 g/dl), fluctuation across thresholds, and area under the curve (AUC). Hb variability was significantly greater among incident patients than prevalent patients. Compared with previously described cohorts in the United States, residual SD was similar but fluctuations above target were less frequent. Using logistic regression, age, body mass index, CVD history, dialysis vintage, serum albumin, Hb, angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) use, ESA use, dialysis access type, dialysis access change, and hospitalizations were significant predictors of high variability. Multivariable adjusted Cox regression showed that SD, residual SD, time-in-target, and AUC did not predict all-cause or CVD mortality during a median follow-up of 12.4 months (IQR: 7.7 to 17.4). However, patients with consistently low levels of Hb (

Original languageEnglish
Pages (from-to)1765-1775
Number of pages11
JournalJournal of the American Society of Nephrology
Issue number10
Publication statusPublished - 2010

ASJC Scopus subject areas

  • Nephrology
  • Medicine(all)


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