促红细胞生成素需求：腹膜透析与血液透析的多中心比较研究

Erythropoietin requirements: a comparative multicenter study between peritoneal dialysis and hemodialysis.

作者信息

Coronel Francisco, Herrero Jose A, Montenegro Jesus, Fernandez Cristina, Gandara Argimiro, Conesa Jose, Rivera M Teresa, Torrente Jaime, Portolés Jose, Gomez-Martino Juan R

机构信息

Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain.

出版信息

J Nephrol. 2003 Sep-Oct;16(5):697-702.

PMID:14733416

Abstract

BACKGROUND

The management of anemia with erythropoietin (EPO) is important in the global treatment of dialysis patients. There is a general impression that anemia control with EPO is obtained more easily in peritoneal dialysis (PD) patients than in hemodialysis (HD) patients. The EPO administration route has to be the same to compare the two techniques adequately.

METHODS

To compare EPO action by subcutaneous (SC) route in HD and PD, 132 stable patients were recruited (HD: 69, PD: 63) from six centers, with adequate dialysis criteria (Kt/V in HD >1.3; weekly Kt/V in PD >1.8). In a cross-sectional study, the EPO dose/week, the number of EPO doses/week, hemoglobin (Hb), ferritin, transferrin saturation index (TS), albumin and intact parathyroid hormone (iPTH) were analyzed. Iron treatment, comorbidity and ACE inhibitors (ACEI) and angiotensin II antagonist (AIIA) treatment were recorded. A multivariate regression model was used in the statistical analysis.

RESULTS

The mean Hb level was the same in both groups, HD 11.6 (1.3) g/dL, PD 11.4 (1.4) g/dL, p=0.3. The SC, EPO doses required to obtain the Hb levels were higher in HD than in PD patients, with a difference of 64.3 u/Kg/week, statistically significant in the multivariate regression model (p=0.001, 95% CI 42.6-86.0). The number of EPO doses/week was also higher in HD patients (65% of HD patients with > or = 3 doses, 19% of PD patients with three or more doses, p<0.001). TS was similar in both groups, while ferritin was higher in HD patients, with a higher percentage of HD patients using intravenous (i.v.) iron (HD 77% vs. PD 49%, p=0.001). Serum albumin and iPTH were lower in PD patients (p<0.001 and p=0.04, respectively), but the percentage of patients with intact parathyroid hormone (iPTH) >500 pg/mL was similar in both groups (HD 17%, PD 14%).

CONCLUSIONS

With the same administration route, PD patients showed a reduced EPO requirement, and less frequent EPO administration than HD patients, to obtain the same Hb level. No other factors, except those involved in better depuration of erythropoiesis inhibitors in PD, seemed responsible for the different EPO requirements.

摘要

背景

使用促红细胞生成素（EPO）治疗贫血在全球透析患者的治疗中具有重要意义。人们普遍认为，与血液透析（HD）患者相比，腹膜透析（PD）患者使用EPO更容易控制贫血。为了充分比较这两种技术，EPO的给药途径必须相同。

方法

为了比较HD和PD患者皮下（SC）途径使用EPO的效果，从六个中心招募了132例稳定患者（HD组69例，PD组63例），这些患者符合充分透析标准（HD患者的Kt/V>1.3；PD患者的每周Kt/V>1.8）。在一项横断面研究中，分析了每周的EPO剂量、每周的EPO给药次数、血红蛋白（Hb）、铁蛋白、转铁蛋白饱和度指数（TS）、白蛋白和完整甲状旁腺激素（iPTH）。记录了铁剂治疗、合并症以及血管紧张素转换酶抑制剂（ACEI）和血管紧张素II拮抗剂（AIIA）的治疗情况。统计分析采用多元回归模型。

结果

两组患者的平均Hb水平相同，HD组为11.6（1.3）g/dL，PD组为11.4（1.4）g/dL，p = 0.3。为达到相同的Hb水平，HD患者皮下注射EPO的剂量高于PD患者，相差64.3 u/Kg/周，在多元回归模型中具有统计学意义（p = 0.001，95%可信区间42.6 - 86.0）。HD患者每周的EPO给药次数也更多（HD患者中65%使用≥3次剂量，PD患者中19%使用三次或更多次剂量，p<0.001）。两组患者的TS相似，而HD患者的铁蛋白更高，HD患者使用静脉铁剂的比例更高（HD组77% vs. PD组49%，p = 0.001）。PD患者的血清白蛋白和iPTH较低（分别为p<0.001和p = 0.04），但两组中完整甲状旁腺激素（iPTH）>500 pg/mL的患者比例相似（HD组17%，PD组14%）。