Rossert Jérôme, Gassmann-Mayer Cristiana, Frei Dieter, McClellan William
Paris-Descartes University and AP-HP (Georges Pompidou European Hospital), Paris, France.
Nephrol Dial Transplant. 2007 Mar;22(3):794-800. doi: 10.1093/ndt/gfl716. Epub 2007 Jan 8.
The required erythropoiesis-stimulating agent (ESA) dose varies when correcting anaemia in chronic kidney disease (CKD) patients. This analysis was performed to identify the prevalence of and factors associated with ESA hyporesponsiveness.
This analysis was a post hoc evaluation of epoetin alfa dosage requirements in a subgroup of patients from the Effect of early Correction of Anemia on the Progression of CKD study. The patients in this subgroup were randomly assigned to the high haemoglobin target group (14-15 g/dl for men and 13-14 g/dl for women) and completed a 4-month haemoglobin stabilization phase with complete epoetin dosage data. The relationship of demographics, disease characteristics and laboratory measures with epoetin dosage were evaluated using Pearson's correlation, association measures and analysis of covariance (ANCOVA) models.
Of the 93 patients evaluated in this subgroup analysis, 14 (15%) were hyporesponsive to epoetin (maximum dosage >100 IU/kg/week during stabilization). An ANCOVA analysis showed that 52% of the observed variability in epoetin dosage at completion of the stabilization phase could be accounted for by diabetes as the primary cause of kidney disease, angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB) use, proteinuria, transferrin saturation, age, pre-treatment haemoglobin, geographical region, serum iron and body mass index (BMI). Unidentified patient characteristics accounted for an additional 16% of the dosage variance.
Older age, higher BMI, anaemia, ACE inhibitor/ARB use and diabetes as the primary cause of kidney disease are associated with increased epoetin requirements when normalizing haemoglobin in anaemic CKD patients.
慢性肾脏病（CKD）患者纠正贫血时所需促红细胞生成素（ESA）剂量存在差异。本分析旨在确定ESA低反应性的患病率及其相关因素。
本分析是对贫血早期纠正对CKD进展影响研究中一个亚组患者的促红细胞生成素α剂量需求进行的事后评估。该亚组患者被随机分配至高血红蛋白目标组（男性为14 - 15 g/dl，女性为13 - 14 g/dl），并完成了为期4个月的血红蛋白稳定期，且有完整的促红细胞生成素剂量数据。使用Pearson相关性分析、关联度量和协方差分析（ANCOVA）模型评估人口统计学、疾病特征和实验室指标与促红细胞生成素剂量的关系。
在该亚组分析评估的93例患者中，14例（15%）对促红细胞生成素低反应（稳定期最大剂量>100 IU/kg/周）。ANCOVA分析显示，稳定期结束时促红细胞生成素剂量观察到的变异性中，52%可由作为肾病主要病因的糖尿病、使用血管紧张素转换酶（ACE）抑制剂/血管紧张素受体阻滞剂（ARB）、蛋白尿、转铁蛋白饱和度、年龄、治疗前血红蛋白、地理区域、血清铁和体重指数（BMI）来解释。未明确的患者特征又占剂量变异性的16%。
年龄较大、BMI较高、贫血、使用ACE抑制剂/ARB以及糖尿病作为肾病的主要病因与贫血CKD患者血红蛋白正常化时促红细胞生成素需求增加有关。
