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Abstract: PO1147

Relationship Between Fluid Overload (FO) and Hemoglobin Concentration (Hgb) in Hemodialysis (HD) Patients (Pts)

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Rivera Fuentes, Lemuel, Renal Research Institute, New York, New York, United States
  • Hakim, Mohamad I., Renal Research Institute, New York, New York, United States
  • Moissl, Ulrich, Fresenius Medical Care AG und Co KGaA, Bad Homburg, Hessen, Germany
  • Mermelstein, Ariella E., Renal Research Institute, New York, New York, United States
  • Raimann, Jochen G., Renal Research Institute, New York, New York, United States
  • Rosales, Laura, Renal Research Institute, New York, New York, United States
  • Kothari, Dewangi Ajay, Renal Research Institute, New York, New York, United States
  • Zhu, Fansan, Renal Research Institute, New York, New York, United States
  • Thijssen, Stephan, Renal Research Institute, New York, New York, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
Background

FO is common in HD pts and the BCM (Fresenius Medical Care, Germany)allows the assessment of fluid volumes and FO. We studied the association between FO and Hgb concentration in a cross-sectional study in four urban US dialysis clinics and tested the effects of inflammation and erythropoiesis-stimulating agents (ESA).

Methods

We conducted BCM measurements in participating HD pts, and obtained Hgb, neutrophil-to-lymphocyte ratio (NLR) and ESA usage from the EMR. The association between FO (stratified into tertiles) and Hgb and NLR, resp., was tested using ANOVA and that between FO and ESA usage using Chi-Square Test. We further employed linear regression, stratified by ESA usage (yes/no), to test associations of FO with Hgb and NLR.

Results

We studied 170 pts (40% female, 52.9% black, 28.2% Hispanic, 61.3±14.4 years, FO 2.2±2.4 L, Hgb 10.9±1.3 g/dL, NLR 3.5±1.9). Greater FO associated with higher NLR (Figure 1a) and lower Hgb (Figure 1b) and also with ESA use (P<0. 001). Hgb negatively correlated with NLR (r=0.1, P=0.10) and FO (r=0.3, P<0. 01). The association between Hgb and FO remained after adjustment for NLR (Beta -0.17, P<0. 01). When the same association was tested separately for pts on ESA and those not on ESA, Hgb was inversely correlated with FO only in patients not on ESA (Beta -0.22, P<0.01), whereas its inverse relationship with NLR remained significant in both subgroups.

Conclusion

FO and inflammation inversely associates to Hgb and deserves consideration in anemia management. BIA can help the clinician assess whether FO may be contributing to low Hgb values. As such, it is a valuable diagnostic tool that should find its way into routine care for US HD pts.