Latar Belakang: Variabilitas hemoglobin (var-Hb) merupakan suatu fenomena fluktuasi kadar Hb dalam satuan waktu tertentu yang dialami oleh pasien penyakit ginjal kronikyang menjalani hemodialisis rutin (PGK-HD).Var-Hb telah diketahui sebagai prediktor independen luaran klinis buruk. Namun,faktor-faktor yang mempengaruhinya belum banyak diketahui. Tujuan: Mengetahui besaran proporsi var-Hb pada pasien PGK-HD di Indonesia dan faktor-faktor yang mempengaruhinya. Metode: Penelitian ini merupakan studi kohort prospektif yang melibatkan pasien GGK-HD berusia ≥18 tahun di Unit Hemodialisis RSCM. Faktor-faktor yang dinilai saat awal ialah kadar Hb, reticulocyte-hemoglobin equivalent(RET-He), albumin, fosfatase alkali, dan C-reactive protein (CRP)serum, serta adekuasi dialisis (Kt/V). Adanya perdarahan saluran cerna(termasuk darah samar feses), dosis erythropoietin-stimulating agent(ESA)dan zat besi, serta kejadian transfusi darah akan dicatat. Kadar Hb kemudian diperiksa setiap 4 minggu hingga 24 minggu pengamatan. Var-Hb dinilai dengan standar deviasi residual dan nilai ≥1,0dianggap sebagai var-Hb tinggi. Uji hipotesis dilakukan dengan uji bivariat sesuai jenis data, dilanjutkan dengan analisis multivariat menggunakan uji regresi logistikmultipel. Hasil: Sejumlah 127 subyek (rerata[SD]usia 49,06[15,1], perempuan 52%, rerata[SD]kadar Hb 9,75[1,00]g/dL) diikutsertakan dalam analisis. Proporsi subyek dengan var-Hb tinggi ialah 47,24%. Berdasarkan analisis bivariat dan multivariat, faktor yang mempengaruhi var-Hb adalah kadar RET-He(p=0,004), dosis ESA (p=0,032), dan kejadian transfusi darah (adjustedOR6,967, IK95% 2,74-17,71;p<0,001). Kesimpulan: Proporsi pasien PGK-HD di Indonesia yang memiliki var-Hb tinggi ialah 47,24%(IK95% 38,3-56,3%). Faktor-faktor yang mempengaruhi var-Hb ialah kadar RET-He,dosis ESA, dan kejadian transfusi darah.

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Background: Hemoglobinvariability(Hb-var) is a phenomenon of Hb fluctuation during a course of time that is frequently observed in chronic kidney disease on hemodialysis (CKD-HD)patients. Hb-varis now recognized asapredictor of poor clinical outcomes. However, factors that influence the Hb-var are not well understood.Objectives.This study was aimedto measure the proportion of Hb-var in CKD-HD patients in Indonesia and identify factors associated. Methods: This was a prospective cohort study involving CKD-HD patients aged ≥18 years old in Hemodialysis Unit in RSCM. Factors identified at baseline were serum levels of Hb,reticulocyte-hemoglobin equivalent (RET-He), albumin,alkalinephosphatase, C-reactive protein (CRP), and dialysis adequacy (Kt/V). Hb level was measured every 4 weeks until 24weeks of follow up. Any evidence of gastrointestinal bleeding (including occult blood feces), erythropoietin-stimulating agent (ESA) dosage, and blood transfusion werealsonoted. Hb-var was calculatedas the residual standardofdeviation, and value ≥1.0 was considered as high.Hypothesis testing was performed by bivariate analysis, thencontinued with multivariateanalysis using multiple regression logistic test. Results: As 127 subjects (mean[SD]of age 49.06[15.1], female 52%, mean[SD]of Hb 9.75[1.00]g/dL) were included in the analysis. The proportion of subjects with high Hb-var were 47.24%. According to bivariate and multivariate analysis, factors that determined Hb-var were RET-Helevels (p=0.004), ESA dosage (p=0.032), and blood transfusion (adjustedOR 6.967, 95%CI2.74-17.71,p<0.001). Conclusion: Theproportion of CKD-HD patients in Indonesia with high Hb-var was47.24% (95%CI 38.3-56.3%). Factors that determined Hb-var wereRET-Helevels, ESA dosage, and blood transfusion.