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Abstract: TH-PO956

Hemoglobin Variability Is Associated with Nutritional Status in Hemodialysis Patients Undergoing Darbepoetin-Alfa Treatment

Session Information

Category: Anemia and Iron Metabolism

  • 200 Anemia and Iron Metabolism


  • Jung, Juyoung, Myongji Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
  • Oh, Dong-jin, Myongji Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
  • Choi, Hye Min, Myongji Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
  • Kwon, Young Eun, Myongji Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
  • Baeg, Song in, Myongji Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)

Anemia is common in hemodialysis (HD) patients, and their response to erythropoietin (EPO) treatment is inconsistent. Fluctuations in hemoglobin levels, known as Hb variability, occur during EPO therapy. This study investigated the association between EPO responsiveness, Hb variability, and nutritional status in HD patients undergoing NESP® (darbepoetin-alfa; Kyowa Kirin Korea Co.,Ltd.) treatment.


This prospective study enrolled 98 adult HD patients (age >20 years, HD vintage >6 months). The target Hb level followed Korean reimbursement guidelines (10-11 g/dL). NESP® dosage adjustments were based on monthly Hb measurements. EPO resistance index (ERI) was calculated as the average weekly NESP® dose divided by Hb level. Hb variability was assessed using Hb-Coefficient of Variation (Hb-CV) with over 24 monthly Hb data points. Nutritional parameters, including body mass index (BMI), fat tissue index (FTI), lean tissue index (LTI), body cell mass index (BCMI), and phase angle (PhA), were evaluated using BCM® (Fresenius Medical Care a Deutschland GmbH, Germany). Clinical and biochemical parameters were also considered.


The study comprised patients with a mean age of 64.0±11.9 years, of which 55.0% were male. HD vintage averaged 54.9±46.8 months, and the follow-up duration was 79.3±47.9 months. Mean Hb level was 10.7±1.3 g/dL. Patients were divided into tertiles based on ERI and Hb-CV. The average ERI was 0.02±0.01, 0.04±0.01, and 0.07±0.03 in ERI-T1, ERI-T2, and ERI-T3, respectively. The ERI-T3 group exhibited lower Hb levels (p=0.038) and higher EPO doses (p=0.001). ERI-T3 correlated with lower PhA (p=0.044), BMI (p=0.001), and FTI (p=0.046). The Hb-CV-T3 group displayed lower BMI (p=0.002) and FTI (p=0.002). FTI was negatively correlated with ERI (r= -0.193, p=0.046) and Hb-CV (r= -0.268, p=0.005) and positively correlated with age (r=0.197, p=0.017) and female sex (r=0.386, p=0.001). Multiple linear regression analysis indicated a negative association between FTI and ERI (β= -0.218, p=0.014) as well as Hb-CV (β= -0.181, p=0.039). Age (β= 0.197, p=0.017) and female sex (β= 0.386, p=0.001) were positively associated with FTI.


Higher EPO resistance and Hb variability were associated with compromised nutritional status, particularly reduced fat tissue, in HD patients on darbepoetin-alfa.