Chronic Kidney Disease (CKD) is a progressive loss in renal function over 3 months of a year. CKD adversely affects thehaematopoietic system, the most common clinical manifestation being anaemia, which contributes to the morbidity and mortality ofthe condition. Hemoglobin levels measured after hemodialysis, compared to those measured before hemodialysis, are suggested tobe a more accurate reflection of the hemoglobin levels between hemodialysis sessions and a better reference point for adjustingerythropoietin dosing. Anaemia may be predictive of an increased risk of mortality in HD patients. The study compared varioushaemoglobin before and after haemodialysis in chronic kidney disease patients in Tertiary Care Hospital. The present observationalstudy was carried out among 55 CKD patients admitted to the hospital for hemodialysis during the study period. Patients withhaematological malignancies, bleeding disorders, and unwillingness to participate were excluded. The collected data were analysedwith proper statistical methods. Out of 55 CKD patients, 43 were men, and 12 were women, with a mean age of 53.20 13.24 years.51 to 70 years old comprised most of our study's age group. Pre-HD and post-HD hemoglobin levels had a p-value of 0.017. Afterhemodialysis, the hemoglobin levels in post-HD patients fell with a statistically significant difference. (p<0.05). Monitoring hemoglobinlevels before and following hemodialysis may aid in avoiding any potential anaemia-related problems, lowering mortality andmorbidity. Although the current study has limitations, additional research is advised for definitive conclusions.

1. Romagnani P, Remuzzi G, Glassock R, Levin A, Jager KJ, Tonelli M et al. Chronic kidney disease. Nat Rev Dis Primers. 2017 Nov 23;3(1):17088. doi: 10.1038/nrdp.2017.88, PMID 29168475.
2. Bal Z, Bal U, Okyay K, Yilmaz M, Balcioglu S, Turgay O, et al. Hematological parameters can predict the extent of coronary artery disease in patients with end-stage renal disease. Int Urol Nephrol. 2015;47(10):1719-25. doi: 10.1007/s11255-015-1073-2, PMID 26246038.
3. Yoon HE, Kim SJ, Hwang HS, Chung S, Yang CW, Shin SJ. Progressive rise in red blood cell distribution width predicts mortality and cardiovascular events in end-stage renal disease patients. PLOS ONE. 2015;10(5):e0126272. doi: 10.1371/journal.pone.0126272, PMID 25961836.
4. Alghythan AK, Alsaeed AH. Hematological changes before and after hemodialysis. Sci Res Essays. 2012;7(4):490-7.
5. ?hemii ?. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int. 2012;2(4):279-335.
6. Parfrey PS, Wish T. Quality of life in CKD patients treated with erythropoiesis-stimulating agents. Am J Kidney Dis. 2010;55(3):423-5. doi: 10.1053/j.ajkd.2009.12.014, PMID 20189050.
7. Parfrey PS, Foley RN, Wittreich BH, Sullivan DJ, Zagari MJ, Frei D. Double-blind comparison of full and partial anemia correction in incident hemodialysis patients without symptomatic heart disease. J Am Soc Nephrol. 2005;16(7):2180-9. doi: 10.1681/ASN.2004121039, PMID 15901766.
8. Pfeffer MA, Burdmann EA, Chen CY, Cooper ME, de Zeeuw D, Eckardt KU, et al. A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. N Engl J Med. 2009;361(21):2019-32. doi: 10.1056/NEJMoa0907845, PMID 19880844.
9. Palmer SC, Navaneethan SD, Craig JC, Johnson DW, Tonelli M, Garg AX, et al. Meta-analysis: erythropoiesis-stimulating agents in patients with chronic kidney disease. Ann Intern Med. 2010;153(1):23-33. doi: 10.7326/0003-4819-153-1-201007060-00252, PMID 20439566.
10. Besarab A, Bolton WK, Browne JK, Egrie JC, Nissenson AR, Okamoto DM, et al. The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N Engl J Med. 1998;339(9):584-90. doi: 10.1056/NEJM199808273390903, PMID 9718377.
11. Kesarkhane M, Haravi R, Kittur S, Dambal A. Study of hematological parameters in end-stage renal disease patients; those on regular hemodialysis as renal replacement therapy. Saudi J Pathol Microbiol. 2020;10(36):348-53.
12. Mohamed Ali MS, Babiker MA, Merghani LB, Ali FA, Abdulmajeed MH. Hematological changes post-hemo and peritoneal dialysis among renal failure patients in Sudan. Saudi J Kidney Dis Transpl. 2008 Mar 1;19(2):274-9. PMID 18310883.
13. Ghimire M, Vaidya S, Upadhyay HP. Clinicodemographic profile and outcome of maintenance hemodialysis patients in a Tertiary Hospital of Central Nepal, Chitwan. Kathmandu Univ Med J (KUMJ). 2020 Jan-Mar;18(69):9-14. doi: 10.3126/kumj.v18i1.33338, PMID 33582680.
14. Agrawaal KK. Maintenance hemodialysis among patients visiting nephrology unit in a tertiary Care Centre: A descriptive cross-sectional study. JNMA J Nepal Med Assoc. 2022 Nov 2;60(255):931-4. doi: 10.31729/jnma.7899, PMID 36705169.
15. Inagaki H, Kuroda M, Watanabe S, Hamazaki T. Changes in major blood components after adopting the supine position during haemodialysis. Nephrol Dial Transplant. 2001;16(4):798-802. doi: 10.1093/ndt/16.4.798, PMID 11274277.
16. Gautam R, Patil PM. Hematological changes in Pre and post hemodialysis in patients with chronic renal failure. J Evid Based Med Healthc. 2018;5(25):1914-9. doi: 10.18410/jebmh/2018/399.
17. Memon M, Shaikh K, Ghafoor A. Faima rani Memon, Salma Mumtaz & Aqsa Naeem. Variations in complete blood count. In: Pre and post hemodialysis patients of chronic renal failure. J. Haematol Stem Cell Res. Vol. 2(2); 2022. p. 73-6.
18. Sagheb MM, Fallahzadeh MA, Moaref A, Fallahzadeh MH, Dormanesh B. Comparison of hemoglobin levels before and after hemodialysis and their effects on erythropoietin dosing and cost. Nephrourol Mon. 2016 Jun 29;8(4):e38495. doi: 10.5812/numonthly.38495, PMID 27713870.
19. Vlassopoulos D, Sonikian M, Dardioti V, Hadjiconstantinou V. Target haematocrit during erythropoietin treatment in dialysis patients. Which value is ‘true-functional haematocrit’? Nephrol Dial Transplant. 1999;14(5):1340-1. doi: 10.1093/ndt/14.5.1340, PMID 10344405.
20. Bellizzi V, Minutolo R, Terracciano V, Iodice C, Giannattasio P, De Nicola L, et al. Influence of the cyclic variation of hydration status on hemoglobin levels in hemodialysis patients. Am J Kidney Dis. 2002;40(3):549-55. doi: 10.1053/ajkd.2002.34913, PMID 12200807.
21. Movilli E, Pertica N, Camerini C, Cancarini GC, Brunori G, Scolari F, et al. Predialysis versus postdialysis hematocrit evaluation during erythropoietin therapy. Am J Kidney Dis. 2002;39(4):850-3. doi: 10.1053/ajkd.2002.32007, PMID 11920353.
22. Castillo N, García-García P, Rivero A, Jiménez-Sosa A, Macía M, Getino MA, et al. Should we adjust erythropoiesis-stimulating agent dosage to postdialysis hemoglobin levels? A pilot study. BMC Nephrol. 2012;13:60. doi: 10.1186/1471-2369-13-60, PMID 22799577.