CRIT-LINE: a noninvasive tool to monitor hemoglobin levels in pediatric hemodialysis patients.

Rouba Garro, Scott Sutherland, Liz Bayes, Steven Alexander, Cynthia Wong
Author Information
  1. Rouba Garro: Department of Pediatrics, Division of Nephrology, Emory University, 2015 Uppergate Drive NE, Atlanta, GA, 30322, USA, rgarro@emory.edu.

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.

References

  1. Adv Chronic Kidney Dis. 2004 Jul;11(3):319-27 [PMID: 15241746]
  2. Am J Kidney Dis. 2006 May;47(5 Suppl 3):S11-145 [PMID: 16678659]
  3. Kidney Int. 2005 Sep;68(3):1337-43 [PMID: 16105069]
  4. Pediatr Nephrol. 2002 Aug;17(8):656-63 [PMID: 12185477]
  5. Pediatr Nephrol. 2005 Mar;20(3):374-9 [PMID: 15549413]
  6. Semin Nephrol. 2000 Jul;20(4):345-9 [PMID: 10928336]
  7. Ann Intern Med. 1989 Dec 15;111(12):992-1000 [PMID: 2688507]
  8. J Am Soc Nephrol. 1998 Dec;9(12 Suppl):S44-54 [PMID: 11443767]
  9. Kidney Int. 2002 Aug;62(2):648-53 [PMID: 12110030]
  10. Clin J Am Soc Nephrol. 2010 Nov;5(11):1939-45 [PMID: 20671221]
  11. Perit Dial Int. 2004 May-Jun;24(3):274-80 [PMID: 15185776]
  12. Am J Kidney Dis. 2001 Oct;38(4):803-12 [PMID: 11576884]
  13. Kidney Int. 2005 Aug;68(2):854-61 [PMID: 16014066]
  14. Arch Dis Child. 1993 Nov;69(5):580-6 [PMID: 8257180]
  15. Nephrol Dial Transplant. 2010 Aug;25(8):2710-4 [PMID: 20176613]
  16. N Engl J Med. 2006 Nov 16;355(20):2085-98 [PMID: 17108343]
  17. J Am Soc Nephrol. 1995 Aug;6(2):214-9 [PMID: 7579087]
  18. Adv Ren Replace Ther. 1996 Jan;3(1):24-36 [PMID: 8620365]
  19. J Pediatr. 2002 Aug;141(2):191-7 [PMID: 12183713]
  20. Clin J Am Soc Nephrol. 2006 Nov;1(6):1205-10 [PMID: 17699349]
  21. Kidney Int. 1998 Nov;54(5):1720-5 [PMID: 9844150]
  22. J Am Soc Nephrol. 1996 May;7(5):763-73 [PMID: 8738812]
  23. JAMA. 1990 Feb 9;263(6):825-30 [PMID: 2404150]
  24. Pediatr Nephrol. 2003 Oct;18(10):1055-62 [PMID: 12883982]
  25. N Engl J Med. 1987 Jan 8;316(2):73-8 [PMID: 3537801]
  26. Nat Rev Nephrol. 2011 Sep 06;7(11):635-41 [PMID: 21894183]
  27. Kidney Int. 1991 Jan;39(1):155-63 [PMID: 2002629]
  28. Am J Kidney Dis. 2002 Feb;39(2):257-65 [PMID: 11840365]
  29. Kidney Int. 1985 Jul;28(1):1-5 [PMID: 3900528]
  30. Am J Kidney Dis. 1996 Apr;27(4):548-56 [PMID: 8678066]
  31. Kidney Int. 2002 Feb;61(2):621-9 [PMID: 11849405]
  32. Am J Kidney Dis. 1999 Dec;34(6):1089-95 [PMID: 10585319]
  33. Hemodial Int. 2013 Oct;17 Suppl 1:S7-10 [PMID: 24134330]
  34. J Lab Clin Med. 1985 Apr;105(4):449-58 [PMID: 3981057]
  35. Kidney Int Suppl. 2002 May;(80):44-8 [PMID: 11982812]
  36. Kidney Int. 2004 Jan;65(1):266-73 [PMID: 14675059]
  37. Am J Kidney Dis. 1996 Jul;28(1):53-61 [PMID: 8712222]
  38. Can J Cardiol. 1990 Jan-Feb;6(1):1-4 [PMID: 2138048]

MeSH Term

Adolescent
Age Factors
Anemia
Biomarkers
Child
Child, Preschool
Equipment Design
Female
Hematinics
Hematocrit
Hemoglobins
Humans
Male
Monitoring, Physiologic
Predictive Value of Tests
Renal Dialysis
Renal Insufficiency, Chronic
Reproducibility of Results
Time Factors
Treatment Outcome
Young Adult

Chemicals

Biomarkers
Hematinics
Hemoglobins

Word Cloud

Created with Highcharts 10.0.0HgblevelsCRIT-LINEpatientsHDreadingsmonitorpediatrichemoglobintargetg/dLanemiamanagementguidehemodialysisreadrespectivelycorrelationlaboratoryusing11willBACKGROUND:nationalaverageachievingKDOQI-recommendedlevel11-12lowcurrentprotocolmeasuringevery2-4weeksinterventionobjectivestudycorrelateinitialactualserumMETHODS:Datacollectedtestsorderedroutineand/orclinicalreasonsconcentrations051Lbloodprocessedbodyweight≤20>20kgUltrafiltrationkeptminimumRESULTS:total21723analyzedResultsshowedstatisticallysignificantmeasurementsr = 094p < 00001Pearsoncoefficientswell-distributeddatameanmeasured12 ± 16331 ± 169CONCLUSIONS:accurateinstrumentmonitoringstudiesneededevaluatewhetherimprovepercentagechildrenwithinCRIT-LINE:noninvasivetool

Similar Articles

Cited By