Macrocytosis may be associated with mortality in chronic hemodialysis patients: a prospective study

Abstract

BackgroundMacrocytosis occurs in chronic hemodialysis (CHD) patients; however, its significance is unknown. The purpose of this study was to establish the prevalence and distribution of macrocytosis, to identify its clinical associations and to determine if macrocytosis is associated with mortality in stable, chronic hemodialysis patients.MethodsWe conducted a single-centre prospective cohort study of 150 stable, adult CHD patients followed for nine months. Macrocytosis was defined as a mean corpuscular volume (MCV) > 97 fl. We analyzed MCV as a continuous variable, in tertiles and using a cutoff point of 102 fl.ResultsThe mean MCV was 99.1 ± 6.4 fl, (range 66-120 fl). MCV was normally distributed. 92 (61%) of patients had an MCV > 97 fl and 45 (30%) > 102 fl. Patients were not B12 or folate deficient in those with available data and three patients with an MCV > 102 fl had hypothyroidism. In a logistic regression analysis, an MCV > 102 fl was associated with a higher Charlson-Age Comorbidity Index (CACI) and higher ratios of darbepoetin alfa to hemoglobin (Hb), [(weekly darbepoetin alfa dose in micrograms per kg body weight / Hb in g/L)*1000]. There were 23 deaths at nine months in this study. Unadjusted MCV > 102 fl was associated with mortality (HR 3.24, 95% CI 1.42-7.39, P = 0.005). Adjusting for the CACI, an MCV > 102 fl was still associated with mortality (HR 2.47, 95% CI 1.07-5.71, P = 0.035).ConclusionsMacrocytosis may be associated with mortality in stable, chronic hemodialysis patients. Future studies will need to be conducted to confirm this finding.

Causes of macrocytic anemia among 628 patients: mean corpuscular volumes of 114 and 130 fL as critical markers for categorization

“…We assigned "hemolytic anemia" to Group 2, although rare exceptional cases can show MCV greater than 130 fL as described above, because those cases are exceptional and the histogram indicated that its peak lies in the normocytic region. These categorizations were consistent with previous surveys of macrocytosis [7-9, 13, 16], as well as with previous reports on each causative disease, such as the one by Tennankore et al, in which the MCV values of all but one (MCV: 120 fL) of the 150 patients with chronic hemodialysis were less than or equal to 114 fL [24].…”

Vitamin B12 Deficiency In Chronic Kidney Disease

“…Similar results were observed by Kartik et al, who observed macrocytosis in 54% of patients of CKD [18]. Other authors also reported similar findings [19][20][21].…”

High Mean Corpuscular Volume Is a New Indicator of Prognosis in Acute Decompensated Heart Failure

“…One possible explanation is that macrocytosis is merely a biomarker for malnutrition, which is often associated with end-stage HF. Given that recently macrocytosis has also emerged as a predictor of mortality and morbidity in patients with various serious diseases, such as squamous cell carcinoma of the esophagus, multiple sclerosis, and end-stage renal disease requiring hemodialysis, [17][18][19] it is likely that macrocytosis is a surrogate marker for end-stage malnutrition. In the present study, among nutrition-related factors, BMI, triglyceride and total cholesterol were significantly lower in the macrocytic group than the non-macrocytic group, but total protein and albumin were similar in both groups.…”