Predictive factors and survival associated with varying degrees of cytopenia in patients undergoing chronic Hemodialysis: A cohort study

Abstract

Background: Anemia and other hematologic abnormalities are common among patients undergoing chronic hemodialysis. Early identification of predictive factors associated with hemogram abnormalities is crucial, as these factors may be linked to overall survival and hematologic disorders.

Method: In March 2021, a total of 478 patients with end-stage renal disease undergoing chronic hemodialysis were enrolled. Cytopenia was categorized into four groups: normal hemogram, single cytopenia, bicytopenia, and pancytopenia. Multivariate analyses were conducted to identify predictive factors for hemogram abnormalities. Survival analysis was performed to evaluate the overall survival of patients with varying degrees of cytopenia over a mean follow-up period of 3.3 years.

Results: Multivariate analyses demonstrated that bicytopenia or pancytopenia was associated with a higher erythropoiesis-stimulating agent resistance index (ERI) (p = 0.007) and serum ferritin levels (p = 0.039). A significant difference in three-year survival was observed between patients with a normal hemogram and those with single cytopenia (p = 0.027), whereas no significant difference was found between patients with single cytopenia and those with either bicytopenia or pancytopenia (p = 0.266). Among patients with the longest duration of dialysis, the presence of any degree of cytopenia was significantly associated with poorer survival outcomes compared to those with a normal hemogram (p = 0.046).

Conclusions: In our study, bicytopenia or pancytopenia in patients undergoing chronic hemodialysis was associated with a higher ERI and elevated serum ferritin levels. In addition, any degree of cytopenia was linked to poorer overall survival among patients with the longest duration of dialysis.

Keywords: Anemia; Hemodialysis; Leukopenia; Survival; Thrombocytopenia.