Although hemoglobin cycling is common among pediatric dialysis patients, anemia severity has a more significant impact on the prevalence of left ventricular hypertrophy (LVH), new study findings suggest.

Sevcan A. Bakkaloğlu, MD, Department of Pediatric Nephrology, School of Medicine, Gazi University, Ankara, Turkey, and collaborators studied 245 pediatric dialysis patients (160 on peritoneal dialysis and 85 on hemodialysis) with a mean age of 12.3 years. They divided patients into 2 groups based on 12-month hemoglobin trajectory: rare cycling (3 or fewer fluctuations, 52% of patients) and frequent cycling (more than 3 fluctuations, 45%). No cycling occurred in 3% of patients. The investigators defined hemoglobin cycling as a greater than 1 g/dL decrease or increase in hemoglobin level. They also grouped patients according to time-averaged hemoglobin levels: less than 10, 10–11, and greater than 11 g/dL.

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The rare cycling and frequent cycling groups did not differ significantly with respect to age, dialysis modality, presence of anemia, residual urine volume, mortality, and hospitalization rate.

LVH prevalence was similar in both groups. Regression analysis showed that frequent cycling was not a risk factor for LVH, but time-averaged low hemoglobin levels (less than 10 g/dL) was, Dr Bakkaloğlu’s group reported online ahead of print in Pediatric Nephrology.

Target hemoglobin levels were achieved more frequently in patients on PD, and the number of deaths was significantly lower among patients without anemia (hemoglobin level above 11 g/dL), according to the investigators.




Bakkaloğlu SA, Kandur Y, Serdaroğlu E, et al. Time-averaged hemoglobin values, not hemoglobin cycling, have an impact on outcomes in pediatric dialysis patients. Pediatr Nephrol. 2018; published online ahead of print.