Kaysen George A, Müller Hans G, Ding Jimin, Chertow Glenn M
Division of Nephrology, Department of Medicine, University of California Davis, Department of Veterans Affairs, Medical Northern California Health Care System, CA, USA.
Am J Kidney Dis. 2006 Jan;47(1):166. doi: 10.1053/j.ajkd.2005.09.013.
With use of recombinant erythropoietin (EPO) and intravenous iron, the majority of hemodialysis patients can achieve target hemoglobin concentrations. EPO resistance arises as a consequence of inflammation and other processes that can adversely affect survival. We hypothesized that the EPO dose-hematocrit (EPO/Hct) ratio, also known as the EPO index, may be a surrogate for inflammation and that greater EPO/Hct ratios would be associated with decreased survival.
We used proportional hazards regression models and time-varying logistic models to analyze the association between EPO index and survival in US hemodialysis patients initiating hemodialysis therapy between January 1, 1999, and December 31, 2000, and followed up for up to 3 years until December 31, 2001.
We found an unexpected and consistent association between greater EPO index and survival in all models. The associations of EPO/Hct ratio were most prominent at intermediate Hct values and with longer dialysis vintage. Iron administration was associated with a lower risk for death independent of Hct. Conversely, greater average prior EPO dose was associated with a greater risk for death.
EPO resistance may be reflected better by total cumulative EPO dose than the EPO/Hct ratio. The mechanism(s) responsible for the association between a greater EPO/Hct ratio and survival remains to be established, but may be a result of nonerythrogenic effects of EPO.
通过使用重组促红细胞生成素（EPO）和静脉铁剂，大多数血液透析患者能够达到目标血红蛋白浓度。EPO抵抗是由炎症和其他可能对生存产生不利影响的过程引起的。我们假设EPO剂量-血细胞比容（EPO/Hct）比值，也称为EPO指数，可能是炎症的替代指标，且更高的EPO/Hct比值与生存率降低相关。
我们使用比例风险回归模型和时变逻辑模型，分析1999年1月1日至2000年12月31日开始接受血液透析治疗并随访至2001年12月31日最长3年的美国血液透析患者中，EPO指数与生存率之间的关联。
我们在所有模型中均发现EPO指数升高与生存率之间存在意外且一致的关联。EPO/Hct比值的关联在中等Hct值和透析时间较长时最为显著。铁剂给药与独立于Hct的较低死亡风险相关。相反，较高的既往平均EPO剂量与较高的死亡风险相关。
与EPO/Hct比值相比，总累积EPO剂量可能更能反映EPO抵抗。EPO/Hct比值升高与生存率之间关联的机制尚待确定，但可能是EPO非促红细胞生成作用的结果。
