Bilirubin-Derived Hemolysis Index as a Predictor of Renal Dysfunction in Hemodialysis Patients: A Retrospective Biochemical Study

Hemolysis is a recognized complication in patients with renal failure undergoing hemodialysis, driven by mechanical, metabolic, and oxidative stress. However, its quantitative assessment remains challenging in low-resource settings due to limited access to direct biomarkers such as plasma free hemoglobin. This study aimed to evaluate hemolysis using a bilirubin-based composite index and to investigate its association with renal dysfunction. A retrospective analytical study was conducted on 100 hemodialysis patients. Hemolysis was calculated using a derived equation integrating total bilirubin, hemoglobin (Hb), and hematocrit (HCT). Statistical analyses included correlation and multivariate regression models. Mean hemolysis was 8.8% ± 3.2. Serum creatinine showed a significant positive correlation with hemolysis (r = 0.61, p < 0.01), while Hb and HCT were negatively correlated. Regression analysis identified creatinine as an independent predictor (β = 2.41, p < 0.01), explaining 52% of variance (R² = 0.52). Compared to international studies, hemolysis levels were markedly lower, primarily due to reduced bilirubin levels. These findings suggest that bilirubin-based estimation may underestimate hemolysis but remains a practical surrogate marker in resource-limited settings.