The association of red blood cell parameters with mortality in a population of hemodialysis patients

Abstract

BBACKGROUND AND OBJECTIVESThe targeting of higher hemoglobin levels leads to increased cardiovascular events in patients with renal disease. This study is an attempt to discover if changes in red blood cell parameters are induced by erythropoiesis‐stimulating agents, and whether these changes are associated with mortality.METHODSA retrospective study of patients on hemodialysis at two dialysis units operated by Our Lady of Lourdes Hospital, Camden, N.J., evaluating the effect of dosage of epoetin alfa on red blood cell parameters and the relationship of these parameters with all cause mortality over the course of one year.RESULTSDosage of epoetin alfa was related to red blood cell distribution width and mean corpuscular hemoglobin concentration in a statistically significant manner. Red blood cell distribution width was significantly lower in one year survivors. Quintile analysis demonstrated a relationship between red blood cell distribution width and iron saturation with one year survival. Low MCHC is a powerful predictor of short term mortality.CONCLUSIONMean corpuscular hemoglobin concentration and red blood cell distribution width are influenced by high doses of epoetin alfa. This study should serve to stimulate further investigation of the predictive role of red blood cell parameters in mortality in patients with renal disease and anemia treated with erythropoiesis stimulating agents, in an attempt to elucidate the mechanism of increased cardiovascular events in patients targeted to higher hemoglobin levels. Dial. Transplant. © 2011 Wiley Periodicals, Inc.

A cohort study of the relationship between anaemia, mean corpuscular volume and mortality among a CKD population in South Africa

“…This finding is consistent with findings of Peng et al 31 , in incident peritoneal dialysis patients, MCV was not statistically significantly associated with mortality in the fully adjusted model, and is consistent with findings of Chen et al 32 among haemodialysis patients, where the two year survival rate was significantly lower in the high red cell distribution width group, Balta et al 33 , found lower death rate among patients with higher MCV, though his cohort were patients with myocardial infarction. This finding is in contrast to findings by Hsieh et al among stage 3–5 CKD patients 34 , Sun et al among peritoneal dialysis patients in Korea, Brain et al 35 and Vashistha et al 36 among haemodialysis patients. The differences in results between our study and other studies may partly be explained by differences in patient characteristics, race, and diverse healthcare delivery systems.…”

Factors influencing survival time of hemodialysis patients; time to event analysis using parametric models: a cohort study

“…Higher MCHC level, which reflects the concentration of hemoglobin in a red blood cell, is another factor that significantly contributes to the increased survival time. According to the vast literature review of ours, there was only one study on patients with ESRD which indicated that low MCHC is associated with lower short term survival [15]. Tennankore et al found that macrocytosis is associated with mortality in stable HD patients [16].…”

Utilizing Extended Red Blood Cell Parameters to Distinguish Iron-Deficient Erythropoiesis - Related Disorders in Malaysian Female Population

“…This study also establishes other effective red cell parameters to distinguish LID from IDA or vice versa as shown in Table 2. The biochemical parameter, serum (ACD) from IDA Other research groups have also considered the utilization of various red cell parameters in characterizing hematological diseases, such as nonsickling hemoglobinopathy [26], chronic nephropathies [27], and even mortality in subjects undergoing hemodialysis [28]. In the future, simple algorithms may even be formulated by arithmetically incorporating more than one routine or eRBC parameters to achieve better distinction between 2 conditions of interest with the aid of ROC curves.…”