title: [Hemoglobin levels in hemodialysis patients treated with epoetin: a Brazilian experience].
abstract: OBJECTIVE
  Correction of anemia using epoetin decreases morbidity and increases survival and quality of life in end-stage renal disease. Maintaining hemoglobin levels within the range proposed by guidelines has become a major challenge, with hemoglobin cycling affecting more than 90% of patients undergoing hemodialysis. The variability of hemoglobin levels over time was assessed in our patients.
  
  
  METHODS
  Data were retrospectively collected on 249 patients undergoing hemodialysis over a 3-year period at seven centers in Brazil. Hemoglobin was measured at least monthly, and target levels were those between 10.5 g/dL and 12.5 g/dL. Patients were grouped into six categories of variability consistently low (<10.5 g/dL), consistently target range (10.5 to 12.5 g/dL), consistently high (>12.5 g/dL), low amplitude fluctuation with low hemoglobin levels, low amplitude fluctuation with high hemoglobin levels and high amplitude fluctuation. None of the patients maintained stable hemoglobin levels for the entire 36-month period.
  
  
  RESULTS
  The mean monthly proportion of patients that had hemoglobin levels within the target range was 50% (range, 42% to 61%). Mean levels above the target (30%) were more frequent than those below it (20%). During 6, 12, and 36 months, proportions of patients with consistently low levels of hemoglobin decreased from 3.6% to 0%, from 31.7% to 2.8% for those with consistently high, from 7.6% to 0% for those with low amplitude fluctuation with low hemoglobin levels and from 41.3% to 8.3% for those with low amplitude fluctuation with high hemoglobin levels. However, the proportions of patients with high amplitude fluctuation increased from 21.5% to 88.9%.
  
  
  CONCLUSIONS
  Maintaining hemoglobin levels within the target range is difficult, especially for longer periods of time. Missing the target seems more often due to levels above it, but high-amplitude fluctuations eventually occur in the majority of patients.
authors.affiliation: Universidade Federal de São Paulo - UNIFESP, São Paulo, SP.
authors.forename: Adriano Luiz
authors.initials: AL
authors.lastname: Ammirati
authors.forename: Renato
authors.initials: R
authors.lastname: Watanabe
authors.forename: Cristiane
authors.initials: C
authors.lastname: Aoqui
authors.forename: Sergio Antonio
authors.initials: SA
authors.lastname: Draibe
authors.forename: Aloisio Barbosa
authors.initials: AB
authors.lastname: Carvalho
authors.forename: Hugo
authors.initials: H
authors.lastname: Abensur
authors.forename: Soraia Stael
authors.initials: SS
authors.lastname: Drumond
authors.forename: João
authors.initials: J
authors.lastname: Moreira
authors.forename: José Luis
authors.initials: JL
authors.lastname: Bevilacqua
authors.forename: Anita C M
authors.initials: AC
authors.lastname: Silva
authors.forename: Fernando
authors.initials: F
authors.lastname: Tatsch
authors.forename: Maria Eugenia
authors.initials: ME
authors.lastname: Canziani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D012016:Reference Values; D006435:Renal Dialysis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa