Hospitalized ESRD Patients Face Long Hemoglobin Recovery Time

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NATIONAL HARBOR, Md.—Nearly two thirds of patients with end-stage renal disease (ESRD) experience a drop in hemoglobin (Hb) level after hospitalization, and it may take months after hospitalization for Hb levels to recover, researchers reported at the National Kidney Foundation 2012 Spring Clinical Meetings.

Given the frequency of hospitalizations in the ESRD population and the length of time for Hb recovery, hospitalizations are significant contributing factors to Hb variability in the ESRD population, the investigators concluded in a poster presentation.

T. Christopher Bond, PhD, of DaVita Clinical Research in Minneapolis, Minn., and colleagues reviewed data from 176,199 hospitalizations (more than 30 days since the last hospitalization) among 138,762 HD patients. The median length of stay was five days. Pre- and post-hospitalization Hb test results were available for 156,353 hospitalizations. Of these, 66.7% were associated with a decrease in Hb from a mean of 11.87 g/dL pre-hospitalization to 10.55 g/dL post-hospitalization.

For all patients who experienced a decrease in Hb levels in the 30 days following hospitalization compared with the 30 days before hospitalization, 46.3% were re-hospitalized before Hb levels recovered to pre-hospitalization levels. The median and mean times for Hb levels to recover were 53 and 112.4 days, respectively.

The time to recovery depended on starting Hb level. Patients within the target Hb range of 10-12 prior to hospitalization recovered to pre-hospitalization levels in a median and mean of 41 and 54.3 days, respectively. Patients with pre-hospitalization Hb levels below 10 recovered in a mean and mean of 29 and 4.7 days, respectively. Those with pre-hospitalization levels above 12 recovered more slowly, with a median and mean time to recovery of 85 and 180.5 days, respectively.

"These data, and evidence that a low proportion of hospitalized [hemodialysis] patients receive ESAs [erythropoiesis-stimulating agents], point to a need for new strategies to control anemia in these patients," the authors stated.

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