Ofsthun Norma, Labrecque John, Lacson Eduardo, Keen Marcia, Lazarus J Michael
Fresenius Medical Care-North America, Lexington, Massachusetts, USA.
Kidney Int. 2003 May;63(5):1908-14. doi: 10.1046/j.1523-1755.2003.00937.x.
The introduction of recombinant human erythropoietin for the treatment of anemia of chronic renal failure provided the opportunity to correct anemia in this patient population. The optimal target hemoglobin for patients with end-stage renal disease (ESRD) remains controversial. A large database of hemodialysis patients was analyzed to determine whether increasing hemoglobin level above the current Kidney Dialysis Outcomes Quality Initiative (K/DOQI) recommendations was associated with increased risk of mortality and hospitalization.
A longitudinal study of hemodialysis patients in Fresenius Medical Care-North America facilities was performed. Selection was restricted to patients in the census for 6 consecutive months from July 1, 1998 through June 30, 2000. Patient mean hemoglobin and other covariates measured during the initial 6 months were related to survival, number of hospitalizations, and length of stay over the subsequent 6 months of follow-up.
Patients with hemoglobin <9 g/dL had an adjusted relative risk of death of 2.11 compared to those patients with 11 </= hemoglobin < 12 g/dL (P < 0.0001). The adjusted relative risk of death was 0.84 for 12 </= hemoglobin < 13 g/dL (P = 0.007). These data suggest there is no increased risk of mortality associated with hemoglobin above the current recommended values. Both number of hospitalizations and length of stay decreased as hemoglobin increased. Patients with hemoglobin >/=13 g/dL had an adjusted length of stay of 9.6 days compared to 10.9 days for those with 11 </= hemoglobin < 12 g/dL (P < 0.0001).
These data indicate the relative risk of death and hospitalization are inversely associated with hemoglobin levels, with no apparent additional risk associated with hemoglobin levels> 12 g/dL.
重组人促红细胞生成素用于治疗慢性肾衰竭贫血，为纠正该患者群体的贫血提供了契机。终末期肾病（ESRD）患者的最佳血红蛋白目标值仍存在争议。分析了一个大型血液透析患者数据库，以确定将血红蛋白水平提高到高于当前肾脏透析预后质量倡议（K/DOQI）建议值是否与死亡率和住院风险增加相关。
对北美费森尤斯医疗护理机构的血液透析患者进行了一项纵向研究。选择范围仅限于1998年7月1日至2000年6月30日连续6个月在普查中的患者。在最初6个月测量的患者平均血红蛋白和其他协变量与随后6个月随访期间的生存率、住院次数和住院时间相关。
血红蛋白<9 g/dL的患者与血红蛋白为11≤血红蛋白<12 g/dL的患者相比，校正后的死亡相对风险为2.11（P<0.0001）。血红蛋白为12≤血红蛋白<13 g/dL时，校正后的死亡相对风险为0.84（P = 0.007）。这些数据表明，血红蛋白高于当前推荐值与死亡风险增加无关。随着血红蛋白升高，住院次数和住院时间均减少。血红蛋白≥13 g/dL的患者校正后的住院时间为9.6天，而血红蛋白为11≤血红蛋白<12 g/dL的患者为10.9天（P<0.0001）。
这些数据表明，死亡和住院的相对风险与血红蛋白水平呈负相关，血红蛋白水平>12 g/dL时无明显额外风险。
