Kidney Week

Abstract: FR-PO793

Hospital-Acquired Anemia in Hemodialysis Patients: Opportunities for Improvement

Session Information

• Dialysis: Hospitalization and Mortality
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Christov, Marta, New York Medical College, Valhalla, New York, United States

Marta Christov,

• Papanagnou, Anastasios, Westchester Medical Center, Bayside, New York, United States

Anastasios Papanagnou,

• Klein, Michael D., Westchester Medical Center, Bayside, New York, United States

Michael D. Klein,

Background

Anemia is a significant comorbidity in end-stage renal disease (ESRD) patients. Hospital-acquired anemia (HAA) is well-described in non-ESRD patients, where it correlates with increased morbidity and mortality. Little is known about the development of HAA in hospitalized ESRD patients and potential modifiable factors.

Methods

We used retrospective chart review to compare hemoglobin (Hgb) on admission, at its lowest (nadir) and on discharge in 52 adult patients with ESRD admitted over a three month period to our medical center. Inclusion criteria were age > 18 years and admission between December 1^st 2016 and February 28^th 2017, as well as a billing code of ESRD (N18.6). Exclusion criteria were: bleeding-related admission, multiple admissions over the observation period, admission longer than 30 days, peritoneal dialysis. We analyzed change in hemoglobin from admission to discharge or admission to nadir and factors that were associated with the changes. Total diagnostic blood volume refers to the total amount of blood drawn by phlebotomy during the stay.

Results

The mean Hgb on admission was 10.6 (+/-1.5) g/dL and the mean discharge Hgb was 9.6 (+/-1.7) g/dL. The mean lowest Hgb was 9.0 (+/- 1.6) g/dL. Total diagnostic blood volume for the admission was significantly correlated with Hgb change from admission to lowest (0.578, p<0.001); 23% of patients required blood transfusions. Age, sex, comorbidities, admission diagnosis and access type were not associated with the change in Hgb, while length of stay and total diagnostic blood volume were associated with a Hgb drop from admission to nadir. We propose a definition of HAA for the ESRD population to include a Hgb decrease from admission to discharge of 1.5 g/dL or greater or need for transfusion.

Conclusion

Hospitalized ESRD patients showed significant decrease in hemoglobin during inhospital stay that correlated most closely with length of stay and total diagnostic blood volume. Strategies to minimize phlebotomy volume in this vulnerable population need to be tested.

Funding

• NIDDK Support