Objective  To explore association of hemoglobin (Hb) variability with mortality and cardio-cerebrovascular events among patients undergoing maintenance hemodialysis (MHD).

  Methods  Totally 216 MHD patients receiving treatment in Tianjin Occupational Diseases Prevention and Treatment Hospital between November 2015 and March 2016 were enrolled in the study. During a 20-month follow-up, the Hb was measured every one or two months and the information on all cause mortality and incidents of cardio-cerebrovascular diseases were collected among the patients to analyze the impact of hemoglobin variability on the mortality and disease events.

  Results  Of all the patients, 122 and 94 were male and female, with an average age of 57 ± 14 years. During the follow-up, 22 died of cardio-cerebrovascular diseases among 43 all-cause mortalities and totally 46 cardio-cerebrovascular events were recorded among all the patients. Multivariate Cox regression analysis indicated that standard deviation (SD) and residual SD of Hb and C reactive protein were independent risk factors for all-cause mortality and cardio-cerebrovascular disease incidents. For the prediction of all-cause mortality and cardio-cerebrovascular events, the area under the receiver operating characteristic (ROC) curve (AUC) was 0.689 for Hb SD, 0.681 for coefficient of variation (CV) of Hb, and 0.693 for mean value of Hb difference (MAGE), respectively.

  Conclusion  Hemoglobin variability, hypoproteinemia and C reactive protein are independent risk factors for all-cause mortality and cardio-cerebrovascular events among hemodialysis patients.