Hemodialysis hematocrit levels

Recombinant human erythropoietin (rHuEpo) may increase the risk of thrombosis (201). It has been reported that patients with carcinoma of the cervix who received chemotherapy and rHuEpo have an increased risk of symptomatic venous thrombosis (201). In clinical trials where the maintenance hematocrit was 3% on PROCRIT clotting of the arteriovenous shunts occurred at an annual rate of about 0.25 events per patient per year. However, other thrombotic conditions such as cerebrovascular events, transient ischemic attacks, myocardial infarction, or pulmonary embolism occurred at a rate of 0,04 events per patient per year (202). In a separate study of I, I I I untreated patients on hemodialysis, clotting of arteriovenous shunts occurred at a rate of 0.5 events per patient per year. In patients with chronic renal failure on hemodialysis who also had congestive heart failure, ischemic heart disease and venous thrombosis were increased in patients who were treated with PROCRIT targeted to a hematocrit level of 42 3% compared to those targeted to 30 3% (202). It has also been reported... 

Predictors for LVH and cardiac failure include age, hypertension, and hemoglobin concentration. In ESRD a Ig/dL fall in hemoglobin increases the relative risk of left ventricular dilation by 1.49, left ventricular systolic dysfunction by 1.55, and death by 1.25. " In patients on dialysis, large observational studies have clearly shown that anemia is associated with increased mortality rates and increased hospitaliza-tion. " In hemodialysis (HD) patients hematocrit levels of 33% to 36% (corresponding to hemoglobin concentration of 11 to 12g/dL) were associated with the lowest risk for all-cause and cardiac mortality,and these patients also had the lowest risk of hospitalization. " " A large randomized controlled trial has tested the hypothesis that normalization of anemia would have benefits in terms of... 

McClellan WM, et al. Subcutaneous erythropoietin results in lower dose and equivalent hematocrit levels among adult hemodialysis patients Results from the 1998 End-Stage Renal Disease Core Indicators Project. Am J Kidney Dis 2001 37 E36. 

Patients suffering from renal failure and receiving dialysis treatment frequently suffer from a normocytic anemia successfully treated with human recombinant erythropoietin, a regulatory protein synthesized by the kidney. However, patients often also exhibit a microcytic, hypochromic anemia that can be separated from the normocytic anemia of renal insufficiency, and that is refractory to erythropoietin (Rosenlof et al. 1990). Al administration to animals produces a similar microcytic anemia (Touam et al. 1983 Fulton and Jeffery 1993). In addition, not only can the anemia be reversed by desferrioxamine treatment (Tielmans et al. 1985), but a prospective clinical study correlated plasma Al levels with severity of the anemia (Short et al. 1980). Patients undergoing hemodialysis with Al-contaminated fluids showed an increased plasma Al and decreased hematocrit both parameters were then reversed when the patients were switched to an Al-free dialysate. 

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