Ifudu O, Uribarri J, Rajwani I, Vlacich V, Reydel K, Delosreyes G, Friedman E A
Renal Disease Division, State University of New York Health Science Center at Brooklyn, Brooklyn, NY 11203, USA.
Am J Kidney Dis. 2000 Dec;36(6):1166-74. doi: 10.1053/ajkd.2000.19830.
Despite the clearly established relationship between adequacy of dialysis and response to erythropoietin, recent guidelines on anemia management in end-stage renal disease (ESRD) omit mention of dialysis adequacy while advocating the use of large amounts of intravenous iron. To determine the relative effects of adequacy of dialysis and intravenous iron on hematocrit, we studied 309 hemodialysis patients and analyzed data from 141 hemodialysis facilities in New York State (ESRD Network 2), as well as data from all 18 ESRD Networks in the United States, for the last quarter of 1997. Among the 309 subjects, mean hematocrit differed between quartiles of urea reduction ratio (URR; F statistic = 4; P: = 0.008). Patients with URRs greater than 70% were 2.6 times more likely to have hematocrits greater than 33% (odds ratio, 2.6; 95% confidence interval [CI], 1.3 to 5.3; P: = 0.009) after adjustment for other factors. Mean dialysis facility (n = 141) hematocrits correlated directly with mean URRs (r = 0.32; P: = 0.001). Facilities with a mean URR greater than 70% were three times more likely to have a mean hematocrit greater than 33% (odds ratio, 3; 95% CI, 1.2 to 7.5; P: = 0.02). The percentage of patients in each of the 18 ESRD Networks with hematocrits of 33% or greater correlated inversely with the percentage of patients administered intravenous iron (r = -0.53; P: = 0.03) after adjustment for dose of erythropoietin. We conclude that adequacy of dialysis predicts the response to erythropoietin at both patient and dialysis facility levels. Patients with low hematocrits primarily because of inadequate dialysis may inappropriately be administered excess intravenous iron intended as a corrective measure.
尽管透析充分性与促红细胞生成素反应之间的关系已明确确立，但近期关于终末期肾病（ESRD）贫血管理的指南在提倡大量使用静脉铁剂时，却未提及透析充分性。为了确定透析充分性和静脉铁剂对血细胞比容的相对影响，我们研究了309例血液透析患者，并分析了纽约州（ESRD网络2）141家血液透析机构的数据，以及美国所有18个ESRD网络在1997年最后一个季度的数据。在309名受试者中，尿素清除率（URR）四分位数之间的平均血细胞比容存在差异（F统计量 = 4；P = 0.008）。在对其他因素进行调整后，URR大于70%的患者血细胞比容大于33%的可能性是其他患者的2.6倍（优势比，2.6；95%置信区间[CI]，1.3至5.3；P = 0.009）。平均透析机构（n = 141）的血细胞比容与平均URR直接相关（r = 0.32；P = 作者：0.001）。平均URR大于70%的机构平均血细胞比容大于33%的可能性是其他机构的3倍（优势比，3；95% CI，1.2至7.5；P = 0.02）。在对促红细胞生成素剂量进行调整后，18个ESRD网络中血细胞比容为33%或更高的患者百分比与接受静脉铁剂治疗的患者百分比呈负相关（r = -0.53；P = 0.03）。我们得出结论，透析充分性在患者和透析机构层面均可预测对促红细胞生成素的反应。主要因透析不充分而血细胞比容低的患者可能会不适当地接受过量静脉铁剂，而这些铁剂原本是作为一种纠正措施使用的。
