The obtained database therefore reflects only a small sample of entire Lithuanian dialysis population. Further studies are needed to clarify the relationship between provided practices, Hb variability, and mortality.3.6. Current Situation and Problems RemainedAs it together was mentioned before Lithuanian anemia management guidelines were revised in August 2011 and correspond to ERBP position (target Hb 100�C120g/L). The mean Hb of our HD patients was 109 �� 12.8g/L at the end of 2011 (P < 0.05 as compared to 2009). 54.7% of all HD patients had Hb between 100�C120g/L, but 26.6% of them still had Hb <100g/L. According to K/DOQI guidelines [2] target of ferritin must be 200�C500mcg/L. There were 46.4% of patients with ferritin in the target range in 2011 although the mean ferritin concentration was 375 �� 255.

7mcg/L. This percentage was similar to that in UK (45.5% in range of 200�C499mcg/L) or in Spain (45.9%) [7]. According to KDIGO [4] and K/DOQI [2] Guidelines additional intravenous iron should not routinely be administered in patients with serum ferritin levels that are consistently >500mcg/L. According to local Lithuanian algorithm administration of iron must be interrupted when ferritin concentration exceeds 500mcg/L; however transferrin saturation is not routinely performed in all Lithuanian HD patients. We determine a dose of iron according to ferritin concentration only, so we cannot accurately evaluate iron stores and prescribe appropriate iron dose. We are planning to continue the study of observation of renal anemia control in Lithuania, the study of Hb variability involving a larger number of patients hoping for more precise results.

It is important to assess the percentage of hyporesponsiveness to ESAs in HD patients in Lithuania and to evaluate the reasons.4. ConclusionsThe history of renal anemia control in Lithuania was complicated; however, a significant improvement was achieved and 54.7% of HD patients reached the target hemoglobin.The involuntary experiment with an intravenous iron occurred in Lithuania because of the economic reasons and confirmed the significant role of intravenous iron in the management of renal anemia.Hemoglobin concentration below 100g/L increased relative hospitalization risk by 1.7-fold and it was one of the most important factors influencing hospitalization rate.Hemoglobin concentration below 100g/L was associated with a 2.

5-fold increased relative risk of death in Lithuanian hemodialysis patients.Although hemoglobin variability was common in Lithuanian hemodialysis patients, it did not independently predict mortality.Conflict of InterestsThe authors declare that there is no conflict of interests.AcknowledgmentThe authors would like to thank Entinostat all Lithuanian colleagues from hemodialysis centers who helped to collect the data about hemodialysis patients.