Comparison of Hemoglobin Levels Before and After Hemodialysis and Their Effects on Erythropoietin Dosing and Cost

Background: hemoglobin levels measured after hemodialysis, as compared to hemoglobin levelsmeasured before hemodialysis, are suggested to be a more accurate reflection of the hemoglobin levels between hemodialysis sessions, and to be a better reference point for adjusting erythropoietin dosing. objectives: the aim of this study was to compare the hemoglobin levels before and after hemodialysis, to calculate the required erythropoietin doses based on these levels, and to develop a model to predict effective erythropoietin dosing. patients and methods: in this cross-sectional study, the hemoglobin levels of 52 patients with end- stage renal disease were measured before and after hemodialysis. the required erythropoietin doses and the differences in cost were calculated based on the hemoglobin levels before and after hemodialysis. a model to predict the adjusted erythropoietin dosages based on posthemodialysis hemoglobin levels was proposed. results: hemoglobin levels measured after hemodialysis were significantly higher than the hemoglobin levels before hemodialysis (11.1  1.1 vs. 11.9  1.2 g/dl, p < 0.001, 7% increase). the mean required erythropoietin dose based on post-hemodialysis hemoglobin levels was significantly lower than the corresponding erythropoietin dose based on pre-hemodialysis hemoglobin levels (10947  6820 vs. 12047  7542 u/week, p < 0.001, 9% decrease). the cost of erythropoietin was also significantly lower when post-hemodialysis levels were used (15.96  9.85 vs. 17.57  11.00 dollars/patient/week, p < 0.001). this translated into 83.72 dollars/ patient/year in cost reduction. the developed model for predicting the required dosage is: erythropoietin (u/week) = 43540.8 + (-2734.8)post-hemodialysis hb* (g/dl). [(r2) = 0.221; *p < 0.001]. conclusions: using post-hemodialysis hemoglobin levels as a reference point for erythropoietin dosing can result in significant dose and cost reduction, and can protect hemodialysis patients from hemoconcentration. the prediction of the erythropoietin adjusted dosage based on post-hemodialysis hb may also help in avoiding overdosage.