Using a non-invasive method in chronic hemodialysis pediatric patients to estimate hemoglobin

Abstract

Background: Maintaining hemoglobin (Hgb) levels within a target range is difficult. Non-invasive hematocrit monitoring (NIVH) continuously monitors both the hematocrit and percent change in intravascular blood volume in real time. Based on the data reported here, NIVH can be utilized as a tool for anemia management in pediatric hemodialysis patients.

Methods: Monthly, mid-week pre-dialysis, Hgb levels were obtained for 12 consecutive months. Concurrent with monthly Hgb, hematocrit was recorded at the start of the dialysis treatment using NIVH. Hgb (oHgb) was calculated using the adult equation Hgb = 0.3112*HCT + 0.71, and a linear regression model was used to derive a pediatric specific equation (pHgb = 0.28*CRIT Hct + 2.5).

Results: A total of 310 observations were obtained from 47 patients. The mean actual hemoglobin (mHgb) was 11.14 ± 1.4, and the mean derived hemoglobin from the adult equation, oHgb, was 10.3 ± 1.3 (p = 0.0001). For the target hemoglobin of 10-12 gm/dl, the adult equation was 72 % sensitive and 63 % specific, whereas the pediatric equation was 93 % sensitive and 70 % specific.

Conclusions: The newly derived pediatric equation (pHgb = 0.28*CRIT Hct + 2.5) improved the prediction capability compared to the standard equation with lower false-negative and false-positive rates.