Volume 6, Issue 2, June 2020, Page: 41-47
Association Between the Distributions of Mean Corpuscular Hemoglobin and Red Blood Cell, and Mortality in a 3-Year Retrospective Study of Hemodialysis Patients
Yoshihiro Tsuji, Department of Medical Engineering, Faculty of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan
Yasumasa Hitomi, Department of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
Naoki Suzuki, Department of Clinical Engineering, Tojinkai Hospital, Kyoto, Japan
Yuko Mizuno-Matsumoto, Graduate School of Applied Informatics, University of Hyogo, Kobe, Japan
Toshiko Tokoro, Department of Nephrology, Tojinkai Satellite Clinic, Kyoto, Japan
Masato Nishimura, Cardiovascular Division, Tojinkai Satellite Clinic, Kyoto, Japan
Received: May 4, 2020;       Accepted: Jun. 15, 2020;       Published: Jun. 29, 2020
DOI: 10.11648/j.ijbecs.20200602.13      View  292      Downloads  127
Introduction: A red blood cell (RBC) concentration of 300 to 350×104/μL and mean corpuscular hemoglobin (MCH) concentration of 30 to 35 pg have been proposed as management target values from the relationship of Hb=RBC×MCH to control anemia, wherein Hb levels should not exceed 12 g/dL. In contrast, even in patients whose Hb levels are maintained at 10 to 12 g/dL, Hb levels are widely distributed when divided into RBC and MCH. Objective: We examined the prognosis in the distribution of MCH and RBC. Methods: Patients were classified into two groups based on MCH and RBC values, wherein patients with MCH≥30 pg but<35 pg and RBC≤350×104/μL (Group I, n=177); and MCH<30 pg and RBC>350×104/μL (Group II, n=217). Associations between all-cause mortality and the distributions of MCH and RBC as well as the iron profiles of these two groups were assessed by Kaplan-Meier curves and Cox proportional hazards regression model, respectively. Results: Patients with MCH<30 pg and RBC>350×104/μL (Group II, n=217) had an increased long-term risk of death and a higher rate of iron deficiency than patients with MCH≥30 pg but<35 pg and RBC≤350×104/μL (Group I, n=177). Conclusions: The management goal for renal anemia would be to control MCH within the range of 30−35 pg and RBC within the range of 300−350×104/μL, and to avoid absolute iron deficiency.
Anemia Management, Hemodialysis, Hemoglobin, Mean Corpuscular Hemoglobin, Red Blood Cell
To cite this article
Yoshihiro Tsuji, Yasumasa Hitomi, Naoki Suzuki, Yuko Mizuno-Matsumoto, Toshiko Tokoro, Masato Nishimura, Association Between the Distributions of Mean Corpuscular Hemoglobin and Red Blood Cell, and Mortality in a 3-Year Retrospective Study of Hemodialysis Patients, International Journal of Biomedical Engineering and Clinical Science. Vol. 6, No. 2, 2020, pp. 41-47. doi: 10.11648/j.ijbecs.20200602.13
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Langston RD, Presley R, Flanders WD, McClellan WM. Renal insufficiency and anemia are independent risk factors for death among patients with acute myocardial infarction. Kidney Int. 2003 Oct; 64 (4): 1398–405.
Yamamoto Y, Nishi S, Tomo T, Masakane I, Saito K, et al: 2015 Japanese Society for Dialysis Therapy: guidelines for renal anemia in chronic kidney disease. Renal Replacement Ther 2017; 3: 36.
Daugirdas JT, Greene T, Depner TA, Chumlea C, Rocco MJ, Chertow GM, et al. Anthropometrically estimated total body water volumes are larger than modeled urea volume in chronic hemodialysis patients: effects of age, race, and gender. Kidney Int 2003 Sep; 64 (3): 1108-1119.
Fishbane S, Berns JS. Hemoglobin cycling in hemodialysis patients treated with recombinant human erythropoietin. Kidney Int. 2005 Sep; 68 (3): 1337-43.
Examination Committee of Criteria for 'Obesity Disease' in Japan, Japan Society for the Study of Obesity. New criteria for 'obesity disease' in Japan. Circ J. 2002 Nov; 66 (11): 987-92.
Hayashi T, Tanaka Y, Iwasaki M, Hase H, Yamamoto H, Komatsu Y, et al. Association of Circulatory Iron Deficiency With an Enlarged Heart in Patients With End-Stage Kidney Disease. J Ren Nutr. 2019 Jan; 29 (1): 39-47.
Ogata H, Kumasawa J, Fukuma S, Mizobuchi M, Kinugasa E, Fukagawa M, et al. The cardiothoracic ratio and all-cause and cardiovascular disease mortality in patients undergoing maintenance hemodialysis: results of the MBD-5D study. Clin Exp Nephrol. 2017 Oct; 21 (5): 797-806.
Yotsueda R, Taniguchi M, Tanaka S, Eriguchi M, Fujisaki K, Torisu K, et al. Cardiothoracic Ratio and All-Cause Mortality and Cardiovascular Disease Events in Hemodialysis Patients: The Q-Cohort Study. Am J Kidney Dis. 2017 Jul; 70 (1): 84-92.
Koo HM, Kim CH, Doh FM, Lee MJ, Kim EJ, Han JH, et al. The relationship of initial transferrin saturation to cardiovascular parameters and outcomes in patients initiating dialysis. PLoS One. 2014 Feb 5; 9 (2): e87231.
Hatamizadeh P, Ravel V, Lukowsky LR, Molnar MZ, Moradi H, Harley K, et al. Iron indices and survival in maintenance hemodialysis patients with and without polycystic kidney disease. Nephrol Dial Transplant. 2013 Nov; 28 (11): 2889-98.
Karaboyas A, Morgenstern H, Pisoni RL, Zee J, Vanholder R, Jacobson SH, et al. Association between serum ferritin and mortality: findings from the USA, Japan and European Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant. 2018 Dec; 33 (12): 2234-44.
Kuragano T, Matsumura O, Matsuda A, Hara T, Kiyomoto H, Murata T, et al. Association between hemoglobin variability, serum ferritin levels, and adverse events/mortality in maintenance hemodialysis patients. Kidney Int. 2014 Oct; 86 (4): 845-54.
Fukasawa H, Ishibuchi K, Kaneko M, Niwa H, Yasuda H, Kumagai H, et al. Red Blood Cell Distribution Width Is Associated With All-Cause and Cardiovascular Mortality in Hemodialysis Patients. Ther Apher Dial. 2017 Dec; 21 (6): 565-71.
Salvagno GL, Sanchis-Gomar S, Picanza A, Lippi G. Red blood cell distribution width: A simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2015; 52: 86-105.
Yokoyama K, Fukagawa M, Akiba T, Nakayama M, Ito K, Hanaki K, et al. Randomised clinical trial of ferric citrate hydrate on anaemia management in haemodialysis patients with hyperphosphataemia: ASTRIO study. Sci Rep. 2019 Jun; 9 (1): 8877.
Yi S, Nanri A, Poudel-Tandukar K, Nonaka D, Matsushita Y, Hori A, et al. Association between serum ferritin concentrations and depressive symptoms in Japanese municipal employees. Psychiatry Res. 2011; 189 (3): 368-72.
Browse journals by subject