Berns J S, Rudnick M R, Cohen R M, Bower J D, Wood B C
Division of Nephrology and Hypertension, Graduate Hospital, Philadelphia, Pennsylvania 19146, USA.
Kidney Int. 1999 Jul;56(1):253-60. doi: 10.1046/j.1523-1755.1999.00531.x.
Hypertension is a recognized complication of partial correction of anemia with recombinant human erythropoietin (epoetin) in hemodialysis patients. We used interdialytic ambulatory blood pressure (ABP) monitoring to study the effects of partially corrected anemia versus normal hematocrit (hct) on BP in hemodialysis patients.
Repeated interdialytic ABP monitoring was performed for up to one year in 28 chronic hemodialysis patients with cardiac disease who were randomized to achieve and maintain normal hct levels (42 +/- 3%, group A) or anemic hct levels (30 +/- 3%, group B) with epoetin. Routine BP measurements obtained at dialysis treatments were also evaluated.
Mean hct levels were 30.7 +/- 0.7% in group A and 30.6 +/- 0.7% in group B at baseline, then 39.3 +/- 1.2% (group A) and 33.5 +/- 0.6% (group B) at four months, and 42.0 +/- 1.1% (group A) and 30.4 +/- 1.0% (group B) at 12 months. Baseline ABP and routine dialysis unit BP levels were not different between the groups. At 2, 4, 8, and 12 months of follow-up, there were no statistically significant differences in any BP parameters between groups or increases in any BP parameters in either group A or group B patients compared with baseline. At 12 months, the mean nighttime diastolic BP (DBP) in group A patients was slightly but significantly lower than the mean daytime DBP (daytime DBP 76.6 +/- 1.9 mm Hg vs. nighttime DBP 72.9 +/- 2.1 mm Hg, P < 0.05). The mean daytime and nighttime BPs were not different from each other at two, four, and eight months in group A or at any time in group B, and in both groups, most patients had little diurnal change in BP.
Correction of hct to normal with epoetin in chronic hemodialysis patients with cardiac disease did not cause increased BP as assessed by interdialytic ABP monitoring or by the measurement of routine predialysis and postdialysis BP. There was little diurnal change in systolic or diastolic BP at baseline or after correction of anemia to normal levels, and although mean nighttime DBP was lower than mean daytime DBP at 12 months in group A, the maintenance of normal hct levels did not affect the abnormal diurnal BP pattern seen at moderately anemic hct levels in most patients.
高血压是血液透析患者使用重组人促红细胞生成素（依泊汀）部分纠正贫血后的一种公认并发症。我们采用透析间期动态血压（ABP）监测来研究部分纠正贫血与正常血细胞比容（hct）对血液透析患者血压的影响。
对28例患有心脏病的慢性血液透析患者进行长达一年的重复透析间期ABP监测，这些患者被随机分组，通过依泊汀使血细胞比容达到并维持在正常水平（42±3%，A组）或贫血血细胞比容水平（30±3%，B组）。还对透析治疗时获得的常规血压测量值进行了评估。
基线时，A组平均血细胞比容水平为30.7±0.7%，B组为30.6±0.7%；4个月时，A组为39.3±1.2%，B组为33.5±0.6%；12个月时，A组为42.0±1.1%，B组为30.4±1.0%。两组间基线ABP和常规透析单元血压水平无差异。在随访的2、4、8和12个月时，两组间任何血压参数均无统计学显著差异，A组或B组患者的任何血压参数与基线相比也无升高。12个月时，A组患者夜间平均舒张压（DBP）略低于白天平均DBP，但差异有统计学意义（白天DBP 76.6±1.9 mmHg vs.夜间DBP 72.9±2.1 mmHg，P<0.05）。A组在2、4和8个月时白天和夜间平均血压无差异，B组在任何时间白天和夜间平均血压也无差异，且两组中大多数患者血压昼夜变化很小。
通过透析间期ABP监测或常规透析前和透析后血压测量评估，对于患有心脏病的慢性血液透析患者，使用依泊汀将血细胞比容纠正至正常水平不会导致血压升高。在基线时或贫血纠正至正常水平后，收缩压或舒张压的昼夜变化很小，并且尽管A组在12个月时夜间平均DBP低于白天平均DBP，但维持正常血细胞比容水平并未影响大多数患者在中度贫血血细胞比容水平时出现的异常血压昼夜模式。
