Na KR, et al. J Korean Med Sci. 2020 Jun;35(28):e257. https://doi.org/10.3346/jkms.2020.35.e257

Hyun Jin Kim, M.D., Ph.D., Manmyung Kim, Ph.D., Hyunjae Zhang, M.E., Hae Ri Kim, M.D., Ph.D., Jae Wan Jeon, M.D., Ph.D., Yuri Seo, M.D., Ph.D., and Qute Choi, M.D., Ph.D.. Ann Lab Med 2025;45:178-84. https://doi.org/10.3343/alm.2024.0304

Short-term hemoglobin (Hb) variability related to volume status is observed in chronic kidney disease (CKD) patients receiving hemodialysis (HD). Given the lack of studies regarding outcomes according to the day of Hb sampling, the existing guidelines do not strongly recommend regarding measurement timing. Pre-dialysis mid-week sampling (Wednesday and Thursday) is preferable to minimize short-term Hb variability, although numerous HD centers perform early-week sampling (Monday and Tuesday). The different measurement days may influence the prescribed dose of erythropoiesis-stimulating agent (ESA) and related patient outcomes. We investigated changes in Hb levels and ESA doses according to the Hb measurement day among HD patients. Starting September 2013, the day for pre-dialysis Hb measurement at the Asan Medical Center was changed from early-week days to mid-week days. This single-center retrospective study evaluated medical records of 92 patients who received maintenance HD between September 2012 and August 2014. There was no significant difference in the mean Hb levels between early-week days and mid-week days (10.71 ± 0.06 g/dL vs. 10.78 ± 0.47 g/dL, p = 0.105). However, the mean doses of darbepoetin-α on early-week days were higher than those on mid-week days (175.4 ± 72.5 μg/month vs. 163.7 ± 83.6 μg/month, p = 0.022). The mean doses of intravenous iron hydroxide sucrose for early-week measurements were also higher than those for mid-week measurements (623.0 ± 489.0 mg/year vs. 447.0 ± 505.2 mg/year, p = 0.001). The mean interdialytic weight gains were 2.81 ± 0.82 kg on early-week days and 1.99 ± 0.61 kg on mid-week days (p < 0.001). Compared with early-week measurements, mid-week pre-dialysis Hb measurements were significantly associated with lower ESA doses without a change in Hb levels.

Background: Albuminuria predicts progression of diabetic nephropathy (DN) but lacks specificity and sensitivity for the diagnosis of chronic kidney disease (CKD) and progressive decline in estimated glomerular filtration rate (eGFR). We evaluated the decline in renal function in patients with DN and analyzed the prognosis of renal function according to the level of albuminuria and the incidence of cardiovascular disease (CVD), cerebrovascular diseases, and peripheral artery disease (PAD) according to the level of albuminuria. Methods: This retrospective study included 331 patients with eGFR > 60 mL/min/1.73 m² and urinary albumin/creatinine (Cr) ratio (ACR) > 30 mg/g Cr who were treated at the Chungnam National University Hospital between January 2012 and December 2018. Patients were divided into mildly increased albuminuria, moderately increased albuminuria, and severely increased albuminuria groups according to their urine ACRs of 30–300, 300–900, and >900 mg/g Cr, respectively. Renal outcomes and incidence of CVD, cerebrovascular disease, and PAD were compared among the three groups.Results: The rate of reduction in eGFR per year was 1.47 ± 6.61 mL/min/1.73 m² in the mildly increased albuminuria, 4.10 ± 8.98 mL/min/1.73 m² in the moderately increased albuminuria, and 9.19 ± 10.39 mL/min/1.73 m² in the severely increased albuminuria (p < 0.001). More severe albuminuria was associated with higher rates of progression to CKD (p < 0.001) and >50% reduction in eGFR from baseline (p < 0.001). There was a statistically significant difference in the rate of PCI with angina or myocardial infarction (p = 0.030). However, cerebrovascular disease and PAD did not significantly differ among the three groups.Conclusion: Among patients with DN who maintained a relatively preserved renal function with an eGFR > 60 mL/min/1.73 m², the rates of renal deterioration and progression to CKD were significantly more frequent in those with more severe albuminuria.