Usefulness of mid-week hemoglobin measurement for anemia management in patients undergoing hemodialysis: a retrospective cohort study

Background Short-term hemoglobin (Hb) variability related to volume status is observed in chronic kidney disease (CKD) patients receiving hemodialysis (HD). Given the lack of studies regarding outcomes according to the day of Hb sampling, the existing guidelines do not strongly recommend regarding measurement timing. Pre-dialysis mid-week sampling (Wednesday and Thursday) is preferable to minimize short-term Hb variability, although numerous HD centers perform early-week sampling (Monday and Tuesday). The different measurement days may influence the prescribed dose of erythropoiesis-stimulating agent (ESA) and related patient outcomes. We investigated changes in Hb levels and ESA doses according to the Hb measurement day among HD patients. Methods Starting September 2013, the day for pre-dialysis Hb measurement at the Asan Medical Center was changed from early-week days to mid-week days. This single-center retrospective study evaluated medical records of 92 patients who received maintenance HD between September 2012 and August 2014. Results There was no significant difference in the mean Hb levels between early-week days and mid-week days (10.71 +/- 0.06 g/dL vs. 10.78 +/- 0.47 g/dL, p = 0.105). However, the mean doses of darbepoetin-alpha on early-week days were higher than those on mid-week days (175.4 +/- 72.5 mu g/month vs. 163.7 +/- 83.6 mu g/month, p = 0.022). The mean doses of intravenous iron hydroxide sucrose for early-week measurements were also higher than those for mid-week measurements (623.0 +/- 489.0 mg/year vs. 447.0 +/- 505.2 mg/year, p = 0.001). The mean interdialytic weight gains were 2.81 +/- 0.82 kg on early-week days and 1.99 +/- 0.61 kg on mid-week days (p < 0.001). Conclusions Compared with early-week measurements, mid-week pre-dialysis Hb measurements were significantly associated with lower ESA doses without a change in Hb levels.