Anemia

Hemoglobin level variability is common in hemodialysis patients with chronic kidney disease. The main objective of the study was to assess the influence of combination therapy (erythropoietin + iron preparations) and monotherapy (erythropoietin) on hemoglobin levels in patients with CKD on maintenance hemodialysis. The study was conducted in 150 patients (102 (68%) males and 48 (32%) females; mean age 51 ±13.8 years) undergoing once/twice/thrice weekly maintenance hemodialysis and were prescribed with combination therapy of erythropoietin + iron preparations and monotherapy of erythropoietin. Hemoglobin levels were estimated once every month prior to hemodialysis session for a period of 5 months. Patients were regularly monitored for side effects. There were significant increases in the serum hemoglobin levels (8.5 ± 2.1 at 1st month to 9.1 ± 1.6 at 5th month) on treatment with combination therapy (p < 0.05). Combination therapy is effective than monotherapy in maintaining the hemoglobin levels (variability) in chronic kidney disease patients on maintenance hemodialysis. 

Variations in Red Blood Corpuscles indices survival can cause clinically important differences in Glycosylated Haemoglobin levels. Many previous studies have shown that Glycosylated Haemoglobin levels did not correlate with the degree of anemia for a given mean plasma glucose and hence Glycosylated Haemoglobin level in patients with iron deficiency anemia should be interpreted with caution.  Glycosylated Haemoglobin level is not affected by degree of anemia or glucose level alone but red blood corpuscles indices, notably Mean Corpuscular Haemoglobin, Mean Corpuscular Haemoglobin Concentration, Platelet Distribution Width, Red Cell Distribution Width & White Blood Cells. fractions may affect. This study has proved that all the above indices are significantly correlated to Glycosylated Haemoglobin levels, thus giving an understanding that Glycosylated Haemoglobin levels in Diabetes with iron deficiency anemia could be interpreted with Red Blood Corpuscles indices.