| Objective: To understand the hemoglobin fluctuations and the relationship with clinical prognosis in maintenance dialysis patients.Methods: Selected 52 cases of maintenance dialysis patients of dialysis time not less than 8 months with integrate dialysis data,observed for 6 months and followed-up for 12 month in blood purification center of Yi Ji Shan Hospital affiliated Wannan Medical College.(1)The observation period:The first detection of hemoglobin as the baseline value when objected patients into the observation period,then every 2 months a hemoglobin detection.Tested venous blood samples collected before dialysis every time.Recorded each hemoglobin values.There were three standards to judge hemoglobin variability:to around hemoglobin target ranged 110-120g/L packet fluctuation model,compared with the baseline value of hem hemoglobin decrease or increase of more than 15g/L and the maximum value and minimum value difference was greater than 15g/L.Taken them as judgment standard to analysis hemoglobin distribution and fluctuation.(2)The followed-up period:Recorded of patients with cardiovascular and cerebrovascular events and death and the reasons,cardiovascular event or death as an endpoint.MHD patients was divided into adverse event group and no adverse event group according to the terminal event.Taken the standard deviation of hemoglobin and the variation coefficient to represent hemoglobin variability.Around the hemoglobin target range divided into 6 groups,that were below the target range group(CL group),around the target range limit of fluctuation group(LAL group), continued in the target range group(CT group),around the target to limit the scope of fluctuation group(LAH group),continued to be higher than the scope of the target group(CH group)and high volatility group(HA group).Compared with the two groups whether there were differences according to the above three standards.MHD patients were divided into low SD group and high SD group,low CV group and high CV group based on the bound of the average number of standard deviation of hemoglobin(SD)and the coefficient of variation(CV).Analyzed the relationship between hemoglobin variability and survival by Kaplan—Meier.Results: In the 52 cases of MHD patients(25 cases of male,27 cases of female)the average age was 54.72±16.12 years,the average duration of dialysis was 37 months,the overall mean Hb levels was 109.75±10.92g/L,the standard deviation(SD)was 7.01±3.10g/L,the coefficient of variation(CV)was 0.064±0.027,the baseline hemoglobin average value was 109.17± 10.40g/L,the followed 3 times respectively was 108.44±10.96g/L,109.37±11.02g/L and 11.202±1.27g/L.During the analyzed period,29 cases of MHD patients hemoglobin values increased or decreased more than 15g/L compared with baseline hemoglobin,27 cases hemoglobin values maximum and minimum value difference was greater than 15g/L,CL group had 11 cases,LAL group had 24 cases,CT group had 7 cases,LAH group had 4 cases,CH group had 1 case and HA group had 5 cases;10 cases of MHD patients developed adverse events,the mean hemoglobin values was 109.53±10.37g/L,among them,2 cases in CL group,3 cases in LAL group,1 case in CT group,1 case in LAH group,3 cases in HA group,compared with no adverse events group,there was significant difference in HA group(P<0.05).The no adverse events group had a higher mean hemoglobin SD and CV comparin-g with the adverse events group(9.54±4.28 vs.6.41±2.44,0.086±0.035 vs.0.059±0.022,re-spectively,P<0.05),Kaplan-Meier analysis showed that high SD group and high CV groups of patients survival rate was less than low SD group and low CV group and HA patients had a lower survival rate than the other 5 groups,(Breslow test,P<0.05),the difference was statistically significant.Conclusion: The study find that hemoglobin variability is common in MHD patients.MHD patients of hemoglobin variability with adverse events is more likely,survival rate is low. |
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