ORIGINAL RESEARCH article
Front. Med.
Sec. Hematology
Association Between Hemoglobin Variability and Mortality in Hemodialysis Patients: A Retrospective Cohort Study
Provisionally accepted
- Zhejiang Chinese Medical University, Hangzhou, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Patients undergoing hemodialysis (HD) face high mortality rates. Monitoring specific laboratory parameters and their derivatives, including hemoglobin (Hb) and its variability, is crucial for improving clinical management and patient outcomes. However, the association between hemoglobin variability and mortality in HD patients remains controversial. Methods: A total of 652 HD patients treated at Wenzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University were included based on predefined criteria. Patients were divided into survival group and death group based on mortality status during the study period for univariate analysis. Based on univariate results, the following parameters representing Hb variability (Hb-Var) were studied: Hb standard deviation (SD), Hb residual SD, Hb coefficient of variation (CV), and Hb abnormal ratio. Cut-off values for each parameter were determined using ROC curves. Patients were stratified into high-risk group and low-risk group based on these cut-off values. Survival analysis was performed using multivariable Cox regression to obtain hazard ratios (HRs) and p-values for each parameter. To ensure robustness, we repeated the same analyses in the subgroup of patients with at least 10 CBC tests. Results: The results of univariate analysis showed that there were statistically significant differences in age (P<0.001), mean Hb (P=0.002), Hb CV (P=0.007), Hb residual SD (P<0.001), and Hb abnormal ratio (P=0.001). ROC curve analysis yielded the following AUC values: Mean Hb HR=0.37 (95%CI: 0.23-0.59, P<0.001), Hb SD HR=1.72 (95%CI: 1.09-2.72, P=0.019), Hb residual SD HR=1.87 (95%CI: 1.20-2.91, P=0.006), Hb CV HR=2.12 (95%CI: 1.34-3.35, P=0.001), Hb abnormal ratio HR=2.30 (95%CI:1.43-3.69, P<0.001). The results of the subgroup were largely similar. Conclusion: Hb-Var included Hb abnormal ratio, Hb residual SD and Hb CV are independent factors associated with mortality in hemodialysis patients.
Keywords: Coefficient of Variation, hemodialysis, Hemoglobin, Mortality, prognosis
Received: 04 Nov 2025; Accepted: 16 Feb 2026.
Copyright: © 2026 Zhou, Wang, lin, Ma and Ji. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Conghua Ji
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.