Haemoglobin Levels Vary in Non-Dialysis CKD Patients

Researchers who analysed data from clinical trials of darbepoetin alfa in anemic non-dialysis CKD patients found that all patients experience some fluctuation in haemoglobin (Hb) levels, although the degree of fluctuation may vary.

Originally published on Renal and Urology News - World Review For Urologists and Nephrologists.

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The findings highlight the difficulties in maintaining Hb within a narrow range when treating anaemia in this patient population. The question to consider is what degree of Hb variability - within or outside target Hb values - is of clinical significance in this population, said lead investigator Anil K Agarwal, MD, associate professor of clinical medicine and director of interventional nephrology at The Ohio State University Medical Center in Columbus

Dr Agarwal and his colleagues focused on data from four U.S-based clinical trials involving a total of 931 patients, 877 of whom were included in this analysis. In two studies, the target Hb range was 10-12 g/dL; in the other two, the target range was 11-13 g/dL.

All studies had a 28-week evaluation period, during which most Hb measurements were within study-specified target ranges. The majority of patients, however, experienced some Hb fluctuations outside these ranges. Intra-patient Hb levels, on average, varied 0.6-0.9 g/dL from subjects' overall mean value.

In addition, Dr Agarwal's group found that hospitalisation due to an adverse event was associated with an increase in Hb variability. Dr. Agarwal hypothesised that the hospitalisations reflect more serious underlying comorbidities that contributed to greater Hb variability.

Higher baseline BMI and higher baseline albumin values were associated with lower variability. 'These [factors] may represent a state of better nutrition and lower inflammation and would be consistent with the observation that low Hb variability is associated with positive outcomes,' Dr Agarwal explained.

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