9%; II 0%, HH 2.2%, LI 8.7%, IH 4.3%, and LH 73.9% of patients (Figure 4).Figure 4Pattern of fluctuations in hemoglobin levels during a six-month period (01/2011�C06/2011) in Lithuanian hemodialysis patients, classified according to Ebben’s principle (n = 100).In the United States www.selleckchem.com/products/Y-27632.html Renal Data System analysed by Ebben et al. [20], only 10% of patients maintained Hb levels within a single Hb category during the entire 6-month period. 29% of patients experienced Hb fluctuations between the high and target Hb groups, and 21% experienced fluctuations between the low and target Hb groups. Fluctuation across all three Hb categories during the 6-month period was observed in nearly 40% of patients [20]. We noted that none of our ESA-treated patients had Hb levels stable within the target range (100�C105g/L) over a 6-month period; 10.

9% of patients had constantly low Hb concentration; 13% strayed outside their initial Hb group into the next closest group, 73.9% of the patients showed a high amplitude swing. However it is difficult to compare our data with data of other studies because a different target range of Hb concentration was used; beside, there is no single and uniformly accepted method to measure Hb variability.The data on the effect of Hb variability on mortality are conflicting. In our study we did not find the association between Hb variability and all-cause mortality using an adjusted Cox regression model, although the Hb concentrations of dead patients had a tendency to be lower (Figure 5) and the mean ESA doses had a tendency to be higher.

Figure 5Comparison of mean hemoglobin concentrations during the year 2011 in dead and alive hemodialysis patients.The study of Ebben et al. suggested that variability itself may not have a strong association with mortality. The key factors seem to be the number and timing of Hb values <110g/L. Patients whose Hb levels were consistently within the target range of 110 to 125g/L experienced the lowest mortality in their study. The longer the amount of time with Hb level <110g/L was the greater the risk of death was noted [19]. In a study involving 34963 HD patients Yang and colleagues reported that the risk of all-cause mortality increased proportionately with Hb variability [21]. The HR and 95% CI per 0.5g/dL, 0.75g/dL, 1.00g/dL, and 1.5g/dL increases in Hb variability were 1.15 (1.10 to 1.2), 1.24 (1.16 to 1.

32), 1.33 (1.22 to 1.45), and 1.53 (1.35 to 1.75), respectively. Not all studies have demonstrated a positive association between Hb variability and death in CKD. Brefeldin_A In the study of Eckardt and colleagues [17] Hb variability was not a statistically significant factor for mortality, except in the group of patients with low amplitude fluctuations and with low Hb levels (HR 1.74, 95% CI 1.00 to 3.04) that correspond to our study data.Our study has limitations that should be considered.