What question did this study set out to answer?

The study aims to investigate how hemoglobin variability affects mortality rates in hemodialysis patients.

March 14, 2026Frontiers in Medicine0 citationsOpen Access

Association between hemoglobin variability and mortality in hemodialysis patients: a retrospective cohort study

ZZZhizhen ZhouZhejiang Chinese Medical University FWFang WangThe Wistar Institute SLSisi LinZhejiang Chinese Medical University

Key Points

The study aims to investigate how hemoglobin variability affects mortality rates in hemodialysis patients.
Analyzed 652 hemodialysis patients from a hospital based on predefined criteria.
Divided patients into survival and death groups for univariate analysis.
Studied parameters representing hemoglobin variability, including standard deviation and coefficient of variation.
Used ROC curves to determine cut-off values for each hemoglobin variability parameter.
Performed multivariable Cox regression to analyze survival and obtain hazard ratios.
Significant differences found in age, mean hemoglobin, and various hemoglobin variability metrics.
Parameters like hemoglobin CV and residual SD were associated with increased mortality risk.
ROC analysis showed that hemoglobin CV and abnormal ratio had high hazard ratios, indicating strong correlations with mortality.

Abstract

Background Patients undergoing hemodialysis (HD) face high mortality rates. Monitoring specific laboratory parameters and their derivatives, including hemoglobin (Hb) and its variability, is crucial for improving clinical management and patient outcomes. However, the association between hemoglobin variability and mortality in HD patients remains controversial. Methods A total of 652 HD patients treated at Wenzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University were included based on predefined criteria. Patients were divided into survival group and death group based on mortality status during the study period for univariate analysis. Based on univariate results, the following parameters representing Hb variability (Hb-Var) were studied: Hb standard deviation (SD), Hb residual SD, Hb coefficient of variation (CV), and Hb abnormal ratio. Cut-off values for each parameter were determined using ROC curves. Patients were stratified into high-risk group and low-risk group based on these cut-off values. Survival analysis was performed using multivariable Cox regression to obtain hazard ratios (HRs) and p -values for each parameter. To ensure robustness, we repeated the same analyses in the subgroup of patients with at least 10 CBC tests. Results The results of univariate analysis showed that there were statistically significant differences in age ( p 0.001), mean Hb ( p = 0.002), Hb CV ( p = 0.007), Hb residual SD ( p 0.001), and Hb abnormal ratio ( p = 0.001). ROC curve analysis yielded the following AUC values: Mean Hb HR = 0.37 (95% CI: 0.23–0.59, p 0.001), Hb SD HR = 1.72 (95% CI: 1.09–2.72, p = 0.019), Hb residual SD HR = 1.87 (95% CI: 1.20–2.91, p = 0.006), Hb CV HR = 2.12 (95% CI: 1.34–3.35, p = 0.001), Hb abnormal ratio HR = 2.30 (95% CI:1.43–3.69, p 0.001). The results of the subgroup were largely similar. Conclusion Hb-Var included Hb abnormal ratio, Hb residual SD and Hb CV are independent factors associated with mortality in hemodialysis patients.

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