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Clin J Am Soc Nephrol. 2010 Nov;5(11):1939-45. doi: 10.2215/CJN.03540410. Epub 2010 Jul 29.

Determining optimum hemoglobin sampling for anemia management from every-treatment data.

Author information

1
University of Louisville, Department of Medicine, Louisville, KY 40202, USA. adam.gaweda@louisville.edu

Abstract

BACKGROUND AND OBJECTIVES:

Anemia management protocols in ESRD call for hemoglobin (Hb) monitoring every 2 to 4 weeks. Short-term Hb variability affects the reliability of Hb measurement and may lead to incorrect dosing of erythropoiesis stimulating agents. We prospectively analyzed short-term Hb variability and quantified the relationship between frequency of Hb monitoring and error in Hb estimation.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

Using the Crit-Line III TQA device, we prospectively observed Hb during each dialysis treatment in 49 ESRD patients and quantified long- and short-term Hb variability. We estimated Hb from data sampled at regular intervals; 8×, 4×, 2×, or 1× per month to establish how well we account for short-term variability at different monitoring intervals. We calculated the Hb estimation error (Hb(err)) as a root mean-squared difference between the observed and estimated Hb and compared it with the measurement error.

RESULTS:

The most accurate Hb estimation is achieved when monitoring 8× per month (Hb(err) = 0.23 ± 0.05 g/dl), but it exceeds the accuracy of the measurement device. The estimation error increases to 0.34 ± 0.07 g/dl when monitoring 4× per month, 0.39 ± 0.08 g/dl when monitoring 2× a month, and 0.45 ± 0.09 g/dl when monitoring 1× per month. Estimation error comparable to instrument error information is as follows: 8× per month, 15 patients; 4× per month, 22 patients; 2× per month, 6 patients; 1× per a month, 6 patients.

CONCLUSIONS:

Four times a month is the clinically optimal Hb monitoring frequency for anemia management.

PMID:
20671221
PMCID:
PMC3001763
DOI:
10.2215/CJN.03540410
[Indexed for MEDLINE]
Free PMC Article

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