The Relationships Between Intra Dialytic Changes in Hemoglobin Level and Myocardial Injury in Patients With ESRD Undergoing Maintenance Hemodialysis

Mansour, Ahmed E.; Bakr, Moaz A.; ElShahawy, El Metwally L.; Ibrahim, Mohamed E.; Moustafa, Shimaa; Salah, Shimaa

doi:10.21608/bmfj.2025.394660.2532

The Relationships Between Intra Dialytic Changes in Hemoglobin Level and Myocardial Injury in Patients With ESRD Undergoing Maintenance Hemodialysis

Articles in Press

Document Type : Original Article

Authors

¹ Assistant professor of internal medicine and nephrology, Faculty of Medicine, Benha University

² M.B.B. Ch, M.Sc. Faculty of Medicine, Benha University

³ Professor of internal medicine and nephrology, Faculty of Medicine, Benha University

⁴ professor of internal medicine and nephrology, Faculty of Medicine, Benha University

⁵ Lecturer of internal medicine and nephrology, Faculty of Medicine, Benha University

⁶ lecturer of internal medicine Faculty of Medicine - Benha University

10.21608/bmfj.2025.394660.2532

Abstract

Background: HD eliminate toxins from the blood through ultrafiltration and diffusion. This study aimed to Study the correlations between intra-dialytic changes in Hb level (post-HD-Hb/pre-HD-Hb) ratio and myocardial injury in patients with CKD (stage 5) who are undergoing maintenance HD and elucidate intradialytic changes of Hb levels in patients with CKD (stage 5) who are receiving maintenance HD. Methods: This prospective study included 100 patients who were divided into four groups according to baseline Hb level (post-Hb/pre-Hb) ratio: Group 1 (n=30) with post-Hb/pre-Hb ratio <1.0, group 2 (n=20) with post-Hb/pre-Hb ratio 1.0 to <1.1, group 3 (n=20) with post-Hb/pre-Hb ratio 1.1 to <1.2 and group 4 (n=30) with post-Hb/pre-Hb ratio ≥1.2. While 4 groups according to post HD Hb level: Group A (n=30) with post Hb level <10 g/dL, group B (n=20) with post Hb level 10 g/dL to < 11 g/dL, group C (n=20) with post Hb level 11 g/dL to < 12 g/dL and group D (n=30) with post Hb level >12 g/dL. Results: hs-cTnT at a cut-off of 12 demonstrated the highest diagnostic accuracy, with the greatest AUC (0.808), balanced sensitivity (75%) and specificity (81.6%), and a high NPV (91.2%), making it a reliable tool for ruling out myocardial injury. hs-cTnI at a cut-off of 8.9 showed a slightly lower AUC (0.796) and specificity (78.9%), comparable sensitivity (75%) and NPV (90.9%), suggesting it is also effective, though slightly less so than hs-cTnT. Conclusion: The asymptomatic raising of hscTni, hscTnt and ckmb represent silient myocardial injury during HD.

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