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Korean Journal of Nephrology 2007;26(4):427-434.

Dae Seong Hwang, M.D., Hyun Chul Chung, M.D., Jun Ho Lee, M.D., Young Tae Hwang, M.D., Jung-Min Seo, M.D., Jong Soo Lee, M.D. and Jongha Park, M.D.

Departments of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

Frequency and Pattern of Hemoglobin Cycling in Korean Hemodialysis Patients Treated with Erythropoiesis Stimulating Agent

Abstract

Purpose
: It is frequently observed that the level of hemoglobin (Hb) widely fluctuates during treatment of erythropoiesis stimulating agents (ESAs) in hemodialysis (HD) patients, known as Hb cycling. The purpose of this study was to describe the frequencies and the characteristics of Hb cycling in Korean HD patients treated with ESA.
Methods
: Data were analyzed for 49 patients on maintenance HD at our unit between August, 2005 and July, 2006. The patients treated with ESA and oral iron ≥6 months before study period were eligible. Only Hb cycles of duration ≥8 weeks and amplitude >1.5 g/dL were included in the analysis.
Results
: Forty-seven of patients (96%) had experienced Hb cycling. The mean number of Hb excursions (a half of Hb cycle) was 2.5±1.3 times/year/person. The mean amplitude and duration of Hb excursions was 2.4±0.7 g/dL and 10.0±4.2 weeks, respectively. The mean nadir Hb level of excursions was 9.2±0.8 g/dL which was quite lower than 10 g/dL, the lower limit of Hb range recommended in Korea. Down Hb excursions were associated with ESA withdrawal in 78.3%. Patients who were frequent cyclers (≥2 times/year/person) significantly had a higher prevalence of diabetes mellitus than others (57.1% vs. 28.6%, p=0.047).
Conclusion
: Hb cycling is a common and a serious feature in HD patients treated with ESA. It is primarily a result of anemia treatment practices, especially holding of ESA and, in part, underlying diabetes.

Key Words: Anemia, Erythropoiesis, Hemoglobin, Renal dialysis