Abstract: Objective To understand the effect of hemoglobin (Hb) fluctuation on cardiovascular prognosis in peritoneal dialysis (PD) patients. Methods We recruited clinical and laboratory data of the PD patients treated in Division of Nephrology, Renji Hospital for more than 3 months in the period from May 1st, 2006 to Sept. 1st, 2011. They were followed up until Dec. 1st, 2011. The absolute value of Hb variation, the trend of Hb variation, and the response of Hb variation to erythropoietin (EPO) were used to analyze the effect of Hb variation on cardiovascular prognosis in PD patients. Results After PD for 3 months, Hb variation
could be analyzed in 333 of the 398 PD patients. In patients with the increase of absolute Hb value of <10g/L and >10g/L, the incidence of new cardiovascular disease (CVD) patients was 27.2% and 12.2% (P<0.05), respectively, and the presence of CVD event was 1/76.2 patients/month and 1/120.1 patients/month, respectively. The percentage of recurrent CVD events in the 3 months of PD was significantly higher in the patients with sustained higher Hb than those in the other 3 Hb variation trend groups (66.7%, P＜0.05). The presence of CVD event was 1/59.2 patients/month in patients with Hb response of <0.01g/L/100IU to EPO treatment, significantly higher than that in the patients with higher Hb response to EPO treatment. Conclusions Hb variation affected the cardiovascular prognosis in PD patients. Our findings suggest that anemia should be treated in PD patients without history of CVD events, and Hb should not be maintained at a higher level in patients with the history CVD events. CVD events occurred more likely in PD patients with lower response to EPO. However, further investigations need to be conducted to confirm our findings.

Key words: Hemoglobin variation, Cardiovascular event, Peritoneal dialysis