I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: greg10 on November 06, 2010, 06:32:52 PM
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As a newbie, my conclusion regarding long term survival on hemodialysis is that it is essential to do fairly long and slow blood flow dialysis and then to carefully monitor the patient's blood work and chemistry. One of the most important blood work for the renal patient is that of the level of hemoglobin. Most dialysis centers will test this once or twice a month, which in my newbie opinion is inadequate - one should really do it every week or every few days. The reason is that the common use of epoetin to elevate the hemoglobin is both a blessing and a curse. It is now clear that excessive use of epotein can result in too high levels of hemoglobin, in which beyond 12 g/dl can be harmful to the vascular system and can cause strokes, heart attacks and embolisms. Recent studies also suggest for older people, higher levels of epoetin is actually correlated with higher mortality.
This is where POCT (Point of Care Testing) hemoglobin with hand held devices comes in. There are now several makes, all costing a few hundred dollars and the test strips or microcuvettes cost about $1.25 to $2.00 for each test. Their accuracy seems adequate and correlates well with laboratory tests. Given the availability of testing of the hemoglobin level near real time using POCT, one should be able to adjust the dose of epoetin to optimize hemoglobin levels in ESRD patients. This is comparable to the use of blood glucose test meters for diabetic patients where one would adjust the insulin injections on a sliding scale to match the blood glucose results.
http://journals.lww.com/poctjournal/Abstract/2003/03000/Point_of_Care_Hemoglobin_Measurement_by_Stat_Site.2.aspx
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At my first clinic, whenever I had monthly blood drawn, my PD nurse would put a tiny bit on a test strip and stick it into a small machine to get an approximation of the hemoglobin on the spot. It was always lower than the official lab numbers from the same blood sample, and the number would drop quickly even while the test strip was plugged into the machine.
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Thank you Restorer. Good to know. I should have put this thread under home dialysis because of course you don't get to do your own epoetin injections in most cases, such as in-center where often you ended having too much epotein for many reasons, some of which has nothing to do with the well being of the patient.
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I've always thought there should be a tester that does this, and also one for other things like phosphorous.. To me its worth sacraficing something else to get the machine if its reliable...
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Interesting thread related to optimizing hemoglobin testing for dialysis patients. There was a study published in July that suggested testing should be done about 8 times per month, instead of the common once or twice per month.
http://www.hemodoc.com/2010/12/how-often-should-we-sample-hb.html
Determining Optimum Hemoglobin Sampling for Anemia Management from Every-Treatment Data
http://cjasn.asnjournals.org/content/5/11/1939.abstract