CRIT-LINE: a Noninvasive Tool to Monitor Hemoglobin Levels in Pediatric Hemodialysis Patients

Overview

Journal Pediatr Nephrol

Specialties Nephrology
Pediatrics

Date 2015 Apr 10

PMID 25854612

Citations 2

Authors

Rouba Garro

Scott Sutherland

Liz Bayes

Steven Alexander

Cynthia Wong

Affiliations

Soon will be listed here.

Abstract

Background: The national average for achieving the KDOQI-recommended hemoglobin (Hgb) target level of 11-12 g/dL is low with the current anemia management protocol of measuring Hgb levels every 2-4 weeks to guide intervention. The objective of this study was to correlate initial Hgb readings from the CRIT-LINE monitor with actual serum Hgb levels in pediatric patients on hemodialysis (HD).

Methods: Data were collected from pediatric HD patients who had Hgb tests ordered for routine and/or clinical reasons. Hgb concentrations were read with the CRIT-LINE after 0.5 or 1 L of blood had been processed by HD in patients with a body weight of ≤20 or >20 kg, respectively. Ultrafiltration was kept at a minimum until the CRIT-LINE Hgb was read.

Results: In total, 217 Hgb readings from 23 HD patients were analyzed. Results showed a statistically significant correlation between CRIT-LINE readings and laboratory Hgb measurements (r = 0.94, p < 0.0001) using Pearson correlation coefficients for well-distributed data. The mean Hgb levels measured by CRIT-LINE and the laboratory were 11.12 ± 1.63 and 11.31 ± 1.69 g/dL, respectively.

Conclusions: The CRIT-LINE monitor is an accurate instrument for monitoring Hgb levels in HD patients. Further studies will be needed to evaluate whether using CRIT-LINE Hgb levels to guide anemia management will improve the percentage of children with Hgb levels within target.

Citing Articles

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References

Chavers B, Herzog C . The spectrum of cardiovascular disease in children with predialysis chronic kidney disease. Adv Chronic Kidney Dis. 2004; 11(3):319-27. DOI: 10.1053/j.arrt.2004.04.002. View

. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis. 2006; 47(5 Suppl 3):S11-145. DOI: 10.1053/j.ajkd.2006.03.010. View

Fishbane S, Berns J . Hemoglobin cycling in hemodialysis patients treated with recombinant human erythropoietin. Kidney Int. 2005; 68(3):1337-43. DOI: 10.1111/j.1523-1755.2005.00532.x. View

Neu A, Ho P, McDonald R, Warady B . Chronic dialysis in children and adolescents. The 2001 NAPRTCS Annual Report. Pediatr Nephrol. 2002; 17(8):656-63. DOI: 10.1007/s00467-002-0928-9. View

Groothoff J, Lilien M, van de Kar N, Wolff E, Davin J . Cardiovascular disease as a late complication of end-stage renal disease in children. Pediatr Nephrol. 2004; 20(3):374-9. DOI: 10.1007/s00467-004-1624-8. View

Collins A, Ma J, Ebben J . Impact of hematocrit on morbidity and mortality. Semin Nephrol. 2000; 20(4):345-9. View

Eschbach J, Abdulhadi M, Browne J, Delano B, Downing M, Egrie J . Recombinant human erythropoietin in anemic patients with end-stage renal disease. Results of a phase III multicenter clinical trial. Ann Intern Med. 1989; 111(12):992-1000. DOI: 10.7326/0003-4819-111-12-992. View

Obrador G, Arora P, Kausz A, Pereira B . Pre-end-stage renal disease care in the United States: a state of disrepair. J Am Soc Nephrol. 2001; 9(12 Suppl):S44-54. View

Chavers B, Li S, Collins A, Herzog C . Cardiovascular disease in pediatric chronic dialysis patients. Kidney Int. 2002; 62(2):648-53. DOI: 10.1046/j.1523-1755.2002.00472.x. View

10.

Gaweda A, Nathanson B, Jacobs A, Aronoff G, Germain M, Brier M . Determining optimum hemoglobin sampling for anemia management from every-treatment data. Clin J Am Soc Nephrol. 2010; 5(11):1939-45. PMC: 3001763. DOI: 10.2215/CJN.03540410. View

11.

Pattaragarn A, Warady B, Sabath R . Exercise capacity in pediatric patients with end-stage renal disease. Perit Dial Int. 2004; 24(3):274-80. View

12.

Kazmi W, Kausz A, Khan S, Abichandani R, Ruthazer R, Obrador G . Anemia: an early complication of chronic renal insufficiency. Am J Kidney Dis. 2001; 38(4):803-12. DOI: 10.1053/ajkd.2001.27699. View

13.

Rodriguez H, Domenici R, Diroll A, Goykhman I . Assessment of dry weight by monitoring changes in blood volume during hemodialysis using Crit-Line. Kidney Int. 2005; 68(2):854-61. DOI: 10.1111/j.1523-1755.2005.00467.x. View

14.

Morris K, Sharp J, Watson S, Coulthard M . Non-cardiac benefits of human recombinant erythropoietin in end stage renal failure and anaemia. Arch Dis Child. 1993; 69(5):580-6. PMC: 1029623. DOI: 10.1136/adc.69.5.580. View

15.

Ho W, Germain M, Garb J, Picard S, Mackie M, Bartlett C . Use of 12x/month haemoglobin monitoring with a computer algorithm reduces haemoglobin variability. Nephrol Dial Transplant. 2010; 25(8):2710-4. DOI: 10.1093/ndt/gfq016. View

16.

Singh A, Szczech L, Tang K, Barnhart H, Sapp S, Wolfson M . Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med. 2006; 355(20):2085-98. DOI: 10.1056/NEJMoa065485. View

17.

Leypoldt J, Cheung A, Steuer R, Harris D, Conis J . Determination of circulating blood volume by continuously monitoring hematocrit during hemodialysis. J Am Soc Nephrol. 1995; 6(2):214-9. DOI: 10.1681/ASN.V62214. View

18.

Jabs K, Harmon W . Recombinant human erythropoietin therapy in children on dialysis. Adv Ren Replace Ther. 1996; 3(1):24-36. DOI: 10.1016/s1073-4449(96)80038-0. View

19.

Parekh R, Carroll C, Wolfe R, Port F . Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr. 2002; 141(2):191-7. DOI: 10.1067/mpd.2002.125910. View

20.

Ebben J, Gilbertson D, Foley R, Collins A . Hemoglobin level variability: associations with comorbidity, intercurrent events, and hospitalizations. Clin J Am Soc Nephrol. 2007; 1(6):1205-10. DOI: 10.2215/CJN.01110306. View