透析充分性可降低血液透析患者重组促红细胞生成素的剂量，且与使用生物相容性膜无关。

Adequacy of dialysis reduces the doses of recombinant erythropoietin independently from the use of biocompatible membranes in haemodialysis patients.

作者信息

Movilli E, Cancarini G C, Zani R, Camerini C, Sandrini M, Maiorca R

机构信息

Division and Chair of Nephrology, Spedali Civili and University of Brescia, Italy.

出版信息

Nephrol Dial Transplant. 2001 Jan;16(1):111-4. doi: 10.1093/ndt/16.1.111.

DOI:10.1093/ndt/16.1.111

PMID:11209002

Abstract

BACKGROUND

The effect of the adequacy of dialysis on the response to recombinant human erythropoietin (rHuEpo) therapy is still incompletely understood because of many confounding factors such as iron deficiency, biocompatibility of dialysis membranes, and dialysis modality that can interfere.

METHODS

We investigated the relationship between Kt/V and the weekly dose of rHuEpo in 68 stable haemodialysis (HD) patients (age 65+/-15 years) treated with bicarbonate HD and unsubstituted cellulose membranes for 6-343 months (median 67 months). Inclusion criteria were HD for at least 6 months, subcutaneous rHuEpo for at least 4 months, transferrin saturation (TSAT) > or = 20%, serum ferritin > or = 100 ng/ml, and haematocrit (Hct) level targeted to 35% for at least 3 months. Exclusion criteria included HBsAg and HIV positivity, need for blood transfusions or evidence of blood loss in the 3 months before the study, and acute or chronic infections. Hct and haemoglobin (Hb) levels were evaluated weekly for 4 weeks; TSAT, serum ferritin, Kt/V, PCRn, serum albumin (sAlb), and weekly dose of rHuEpo were evaluated at the end of observation. No change in dialysis or therapy prescription was made during the study.

RESULTS

The results for the whole group of patients were: Hct 35 +/- 1.2%, Hb 12.1 +/- 0.6 g/dl, TSAT 29 +/- 10%, serum ferritin 204 +/- 98 ng/ml, sAlb 4.1 +/- 0.3 g/dl, Kt/V 1.33 +/-0.19, PCRn 1.11+/- 0.28 g/kg/day, weekly dose of rHuEpo 123 +/- 76 U/kg. Hct did not correlate with Kt/V, whereas rHuEpo dose and Kt/V were inversely correlated (r = -0.49; P < 0.0001). Multiple regression analysis with rHuEpo as dependent variable confirmed Kt/V as the only significant variable (P < 0.002). Division of the patients into two groups according to Kt/V (group A, Kt/V < or = 1.2; group B, Kt/V > or = 1.4), showed no differences in Hct levels between the two groups, while weekly rHuEpo dose was significantly lower in group B than in group A (group B, 86 +/- 33 U/kg; group A, 183 +/- 95 U/kg, P < 0.0001).

CONCLUSIONS

In iron-replete HD patients treated with rHuEpo in the maintenance phase, Kt/V exerts a significant sparing effect on rHuEpo requirement independent of the use of biocompatible synthetic membranes. By optimizing rHuEpo responsiveness, an adequate dialysis treatment can contribute to the reduction of the costs of rHuEpo therapy.

摘要

背景

由于存在许多干扰因素，如缺铁、透析膜的生物相容性和透析方式等，透析充分性对重组人促红细胞生成素（rHuEpo）治疗反应的影响仍未完全明确。

方法

我们调查了68例稳定的血液透析（HD）患者（年龄65±15岁）的Kt/V与rHuEpo每周剂量之间的关系，这些患者接受碳酸氢盐HD和未替代的纤维素膜治疗6 - 343个月（中位数67个月）。纳入标准为HD至少6个月、皮下注射rHuEpo至少4个月、转铁蛋白饱和度（TSAT）≥20%、血清铁蛋白≥100 ng/ml，且血细胞比容（Hct）水平至少3个月维持在35%。排除标准包括乙肝表面抗原和HIV阳性、在研究前3个月内需要输血或有失血证据，以及急慢性感染。在4周内每周评估Hct和血红蛋白（Hb）水平；在观察结束时评估TSAT、血清铁蛋白、Kt/V、PCRn、血清白蛋白（sAlb）和rHuEpo每周剂量。研究期间透析或治疗处方未改变。

结果

整个患者组的结果为：Hct 35±1.2%，Hb 12.1±0.6 g/dl，TSAT 29±10%，血清铁蛋白204±98 ng/ml，sAlb 4.1±0.3 g/dl，Kt/V 1.33±0.19，PCRn 1.11±0.28 g/kg/天，rHuEpo每周剂量123±76 U/kg。Hct与Kt/V无相关性，而rHuEpo剂量与Kt/V呈负相关（r = -0.49；P < 0.0001）。以rHuEpo为因变量的多元回归分析证实Kt/V是唯一显著变量（P < 0.002）。根据Kt/V将患者分为两组（A组，Kt/V≤1.2；B组，Kt/V≥1.4），两组Hct水平无差异，而B组rHuEpo每周剂量显著低于A组（B组，86±33 U/kg；A组，183±95 U/kg，P < 0.0001）。