Determining Optimum Hemoglobin Sampling for Anemia Management
from Every-Treatment Data Clinical Journal of the American Society of Nephrology - Published ahead of print on September 28, 2010
Adam E. Gaweda, Brian H. Nathanson, Alfred A. Jacobs, George R. Aronoff, Michael J. Germain, and Michael E. Brier
Department of Medicine, University of Louisville, Louisville, Kentucky; OptiStatim, LLC, Longmeadow, Massachusetts; Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts; and Robley Rex Medical Center, Department of Veterans Affairs, Louisville, Kentucky
Submitted by Mr CS Soong
Abstract
Background and objectives: Anemia Management Protocols in ESRD call for hemoglobin (Hb) monitoring every 2 to 4 weeks. Short-term Hb variability affects the reliability of Hb measurement and may lead to incorrect dosing of erythropoiesis stimulating agents. We prospectively analyzed short-term Hb variability and quantified the relationship between frequency of Hb monitoring and error in Hb estimation.
Design, setting, participants, & measurements: Using the Crit-Line III TQA device, we prospectively observed Hb during each dialysis treatment in 49 ESRD patients and quantified long- and short-term Hb variability. We estimated Hb from data sampled at regular intervals; 8x, 4x, 2x, or 1x per month to establish how well we account for short-term variability at different monitoring intervals. We calculated the Hb estimation error (Hberr) as a root mean-squared difference between the observed and estimated Hb and compared it with the measurement error.
Results: The most accurate Hb estimation is achieved whenmonitoring 8x per month (Hberr = 0.23 ¡¾ 0.05 g/dl), but it exceeds the accuracy of the measurement device. The estimation error increases to 0.34 ¡¾ 0.07 g/dl when monitoring 4x per month, 0.39 ¡¾ 0.08 g/dl when monitoring 2x a month, and 0.45 ¡¾ 0.09 g/dl when monitoring 1x per month. Estimation error comparable to instrument error information is as follows: 8x per month, 15 patients; 4x per month, 22 patients; 2x per month, 6patients; 1x per a month, 6 patients.
Conclusions: Four times a month is the clinically optimal Hb monitoring frequency for anemia management
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