Why is hemoglobin better on daily hemo?

I’ve had terrific lab results consistently since starting short daily hemo 2-1/2 months ago - virtually all normal pre-treatment across the board!

One thing I’m not sure about is why daily hemo helps to increase hemoglobin. In just 2 months, I went from a hemoglobin of under 120 to one of 128. I haven’t had hemoglobin this high since about 3-4 years pre-dialysis. My small dose of Eprex remains unchanged, so, it’s got to be something related to the daily dialysis.

It would seem to me that doing dialysis twice as many times per week would cause twice as much blood to be lost to the process (even with rinseback, there’s always a little blood left out). I’m guessing it’s the better appetite and consequently better nutrition (this is borne out by my albumin (from 41 previously on 3/week to 46 now), and perhaps less blood loss in reality due to more attentive and better rinseback compared to how its done in-centre (where the staff is usually in a bit of a rush).

Any ideas?


Pierre, I’ve had the same sort of experience. I stopped EPO altogether last July and my hemoglobin has been as high as 14 (around December). Recently it has dropped to 12.2 and they started me back on a 2,000 u a week dose to try to prevent it from bottoming out. I asked your question of Dr. Eschbach who did the initial EPO studies. He pointed out that there are two things going on with anemia in dialysis patients.

On the one hand our kidneys may not be producing the hormone (EPO) to stimulate red blood cell production but the other issue is that our blood cells don’t live as long. Blood cells in a healthy individual live about 120 days, while blood cells in a person on incenter dialysis may live only 60 days. When you switch to daily hemo your blood is cleaner and your blood cells can live longer.

To explain why not everyone has our experience and why some may continue to need EPO, it may depend on the underlying disease. Pierre I suspect that your and my kidneys are still producing some EPO, while someone with a different cause of their kidney failure may not produce any. So it is probably a combination of factors but an important factor is longevity of the individual blood cells.

Thanks for that Bill. I didn’t know about the blood cell lifespan aspect of it.

My dose of Eprex has always been only 2000 units once per week. I could even go without it now, but my doctor says she wants to let me enjoy the better hemoglobin :slight_smile:


In my example, I don’t have any kidneys at all…they were taken out, so I rely on Epogen 2x a week…

I also take iron, but orally and not through I.V. …also 2x a week…

In my experience it varies, at some points you may need to withdraw from using EPogen because the labs are too good, but also there’s points where you will need it again…how you eat and what you eat is a factor on how good your blood will maintain, so when adding extra dialysis your keeping the excess fluid and toxics at bay and not hurting your blood cells with all the overload of just doing 3x a week…