Roberts Tricia L, Obrador Gregorio T, St Peter Wendy L, Pereira Brian J G, Collins Allan J
Nephrology Analytical Services, Minneapolis Medical Research Foundation, Minneapolis, Minnesota 55404, USA.
Kidney Int. 2004 Dec;66(6):2429-36. doi: 10.1111/j.1523-1755.2004.66020.x.
Arteriovenous fistulas are the recommended permanent vascular access (VA) for chronic hemodialysis. However, in the United States most patients begin chronic hemodialysis with a catheter. Recent data suggest that VA type contributes to recombinant human erythropoietin (rHuEPO) resistance. We examined catheter insertions, VA infections, and anemia management in Medicare, rHuEPO-treated, chronic hemodialysis patients.
We compared hemoglobin values and rHuEPO and intravenous iron dosing with concurrent catheter insertions and VA infections in 186,348 period-prevalent patients in 2000. We studied anemia management after catheter insertions and VA infections in 67,410 incident patients from 1997 to 1999. Multiple linear regression models examined follow-up hemoglobin and rHuEPO dose per week (rHuEPO/wk) by numbers of catheter insertions and hospitalizations for VA infection.
In the prevalent cohort, increasing temporary and permanent catheter insertions and VA infections were associated with slightly lower hemoglobin, higher rHuEPO doses, and higher intravenous iron doses. In the incident cohort, compared to patients with no VA infections or no catheter insertions (temporary or permanent), respectively, patients with 2+ VA infections or 2+ catheter insertions had 0.12 g/dL and 0.06 g/dL lower mean hemoglobin (P = 0.0028 and P < 0.0001), and 25.7% and 12.2% higher mean rHuEPO/wk (P < 0.0001).
Higher rHuEPO doses may be required to maintain similar or slightly lower mean hemoglobin values among chronic hemodialysis patients with higher numbers of catheter insertions and VA infections, compared to patients without any.
动静脉内瘘是慢性血液透析推荐使用的永久性血管通路（VA）。然而，在美国，大多数患者开始慢性血液透析时使用的是导管。近期数据表明血管通路类型会导致重组人促红细胞生成素（rHuEPO）抵抗。我们研究了医疗保险覆盖的、接受rHuEPO治疗的慢性血液透析患者的导管插入情况、血管通路感染及贫血管理。
我们比较了2000年186348例期间患病率患者的血红蛋白值、rHuEPO及静脉铁剂用量与同期导管插入情况和血管通路感染情况。我们研究了1997年至1999年67410例新发病例患者在导管插入和血管通路感染后的贫血管理情况。多元线性回归模型通过导管插入次数和血管通路感染住院次数来研究随访血红蛋白和每周rHuEPO剂量（rHuEPO/周）。
在现患队列中，临时和永久性导管插入次数增加以及血管通路感染与略低的血红蛋白、更高的rHuEPO剂量和更高的静脉铁剂剂量相关。在新发病例队列中，与无血管通路感染或无导管插入（临时或永久性）的患者相比，分别有2次以上血管通路感染或2次以上导管插入的患者平均血红蛋白分别低0.12 g/dL和0.06 g/dL（P = 0.0028和P < 0.0001），平均rHuEPO/周分别高25.7%和12.2%（P < 0.0001）。
与无导管插入和血管通路感染的患者相比，慢性血液透析患者中导管插入次数和血管通路感染次数较多者可能需要更高的rHuEPO剂量来维持相似或略低的平均血红蛋白值。
