title: Hospitalization and mortality in hemodialysis patients: association with hemoglobin variability.
abstract: OBJECTIVE
  Hemodialysis patients show complications associated with low or high hemoglobin (Hb), which occur frequently in clinical practice. We sought to determine the clinical importance of these changes in Hb levels.
  
  
  METHODS
  From our clinic cohorts, we identified 1,634 who met inclusion criteria for analysis of hospitalization frequency and 1,953 analysis of mortality; many patients were in both groups. Hb excursions outside the target range (11-12.5 g/dl) were studied in relation to patient outcomes.
  
  
  RESULTS
  Hb measures below range were associated with more frequent hospitalization (p < 0.001), increased length of stay (p < 0.001), and increased mortality (p < 0.01), whereas Hb above range was associated with a reduced frequency of hospitalization (p < 0.01) and shorter length of stay (p < 0.01), and tended to be associated with reduced mortality.
  
  
  CONCLUSIONS
  Excursions below range were associated with negative outcomes, but excursions above range were either beneficial or neutral. Our findings indicate that clinicians should focus on low Hb as a negative indicator of patient status, whereas transient Hb above range is a marker for patient health and well-being.
authors.affiliation: University of Massachusetts, Lowell, MA 01854, USA. garry_handelman@uml.edu
authors.forename: Garry J
authors.initials: GJ
authors.lastname: Handelman
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
authors.forename: Miriam G
authors.initials: MG
authors.lastname: Cisternas
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hoenich
authors.forename: Len
authors.initials: L
authors.lastname: Usvyat
authors.forename: Martin
authors.initials: M
authors.lastname: Kuhlmann
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Levin
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism*; D006760:Hospitalization; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006454:Hemoglobins