Determining optimum hemoglobin sampling for anemia management from every-treatment data.

BACKGROUND AND OBJECTIVES: Anemia management protocols in ESRD call for hemoglobin (Hb) monitoring every 2 to 4 weeks. Short-term Hb variability affects the reliability of Hb measurement and may lead to incorrect dosing of erythropoiesis stimulating agents. We prospectively analyzed short-term Hb variability and quantified the relationship between frequency of Hb monitoring and error in Hb estimation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using the Crit-Line III TQA device, we prospectively observed Hb during each dialysis treatment in 49 ESRD patients and quantified long- and short-term Hb variability. We estimated Hb from data sampled at regular intervals; 8×, 4×, 2×, or 1× per month to establish how well we account for short-term variability at different monitoring intervals. We calculated the Hb estimation error (Hb(err)) as a root mean-squared difference between the observed and estimated Hb and compared it with the measurement error.
RESULTS: The most accurate Hb estimation is achieved when monitoring 8× per month (Hb(err) = 0.23 ± 0.05 g/dl), but it exceeds the accuracy of the measurement device. The estimation error increases to 0.34 ± 0.07 g/dl when monitoring 4× per month, 0.39 ± 0.08 g/dl when monitoring 2× a month, and 0.45 ± 0.09 g/dl when monitoring 1× per month. Estimation error comparable to instrument error information is as follows: 8× per month, 15 patients; 4× per month, 22 patients; 2× per month, 6 patients; 1× per a month, 6 patients.
CONCLUSIONS: Four times a month is the clinically optimal Hb monitoring frequency for anemia management.