Abstract: Objective To determine the relationship between hemoglobin variability and mortality in maintenance hemodialysis (MHD) patients. Methods A total of 364 MHD cases were recruited from Shanghai Renal Registry Network. The relationship between hemoglobin variability and all-cause mortality was assessed. Results In the 364 MHD cases, the average age was 63.07±13.93 years, the dialysis vintage was 76.0 (42.25, 134.0) months, and 85 patients (23%) died. The dead patients had a higher mean hemoglobin SD and CV comparing with the survival patients (19.19±6.31 vs. 13.74±5.89, and 0.172±0.07 vs. 0.126±0.056, respectively, P＜0.001). Risk of all- cause mortality in patients in the upper quartile (P75) of hemoglobin SD was significantly higher than those in the lower quartile (P25) (OR=5.964, 95% CI 2.663～13.357, P＜0.001), even after adjustment for demographic data, lifestyle factors and biochemical markers (OR=4.961, 95% CI 1.959～11.238, P＜0.001). Kaplan-Meier method showed that patients with hemoglobin SD and CV in the upper quartile had a lower survival rate (P＜0.001). ROC-AUC of hemoglobin SD and CV for all-cause mortality were 0.677 and 0.721, respectively (cutoff 10.647g/l and 0.1086, respectively; accuracy 89.4% and 85.1%, respectively; specificity 67.7% and 60.3%, respectively; P＜0.001). Multivariate logistic regression analysis showed that higher hemoglobin CV, older age and higher CRP were the independent risk factors for all-cause mortality. Conclusions The highest hemoglobin SD and CV were independently correlated with all- cause mortality. Hemoglobin variability may have prediction value for mortality in MHD patients.

Key words: maintenance hemodialysis, hemoglobin, variability