Wei Mingxin, Bargman Joanne M, Oreopoulos Dimitrios G
Home Peritoneal Dialysis Unit, University Health Network and University of Toronto, Toronto, ON, Canada.
Int Urol Nephrol. 2007;39(3):935-40. doi: 10.1007/s11255-007-9226-6. Epub 2007 May 30.
The present study was aimed at investigating the factors related to hypo-responsiveness to erythropoietin in patients on chronic peritoneal dialysis (PD).
We studied 44 patients with end-stage renal disease who had been on PD for more than 6 months and on erythropoietin (EPO) >/=6,000 U/week for more than 3 months. We expressed EPO resistance index (ERI) as weekly EPO dose per hematocrit (Hct) per body weight. The dose of EPO was titrated to maintain a target Hct level between 33% and 36%. Patients were divided into two groups according to weekly EPO dose. We compared the various factors in those two groups and, by using correlation and linear regression analysis, investigated factors that might predict EPO resistance.
There were 13 patients in the EPO <150 U/kg per week group and 31 patients in the EPO >/=150 U/kg per week group. Among those 31 patients, there were five patients on EPO >/=300 U/kg per week. Compared to the EPO <150 U/kg per week group, the EPO >/=150 U/kg per week group had a lower normalized protein catabolic rate (nPCR), lower level of serum albumin and higher C-reactive protein (CRP). Correlation analysis showed that the ERI had a statistically significant correlation with CRP (r = 0.303, P < 0.05), serum albumin (r = -0.26, P < 0.05), parathyroid hormone (PTH) (r = -0.307, P < 0.05) and nPCR (r = -0.259, P < 0.05). These results show that CRP, serum albumin, PTH and nPCR are factors related to hypo-responsiveness. Multiple stepwise linear regression analysis showed that CRP was the most important independent predictor of EPO hypo-responsiveness.
CRP, serum albumin, nPCR and PTH are factors related to hypo-responsiveness. Inflammation contributes significantly to EPO hypo-responsiveness.
本研究旨在调查慢性腹膜透析（PD）患者对促红细胞生成素低反应性的相关因素。
我们研究了44例终末期肾病患者，这些患者接受腹膜透析超过6个月，且接受促红细胞生成素（EPO）≥6,000 U/周超过3个月。我们将EPO抵抗指数（ERI）表示为每周每体重每血细胞比容（Hct）的EPO剂量。调整EPO剂量以维持目标Hct水平在33%至36%之间。根据每周EPO剂量将患者分为两组。我们比较了两组中的各种因素，并通过相关性和线性回归分析，研究了可能预测EPO抵抗的因素。
每周EPO<150 U/kg组有13例患者，每周EPO≥150 U/kg组有31例患者。在这31例患者中，有5例患者每周EPO≥300 U/kg。与每周EPO<150 U/kg组相比，每周EPO≥150 U/kg组的标准化蛋白分解代谢率（nPCR）较低，血清白蛋白水平较低，C反应蛋白（CRP）较高。相关性分析表明，ERI与CRP（r = 0.303，P < 0.05）、血清白蛋白（r = -0.26，P < 0.05）、甲状旁腺激素（PTH）（r = -0.307，P < 0.05）和nPCR（r = -0.259，P < 0.05）有统计学显著相关性。这些结果表明，CRP、血清白蛋白、PTH和nPCR是与低反应性相关的因素。多元逐步线性回归分析表明，CRP是EPO低反应性最重要的独立预测因素。
CRP、血清白蛋白、nPCR和PTH是与低反应性相关的因素。炎症对EPO低反应性有显著影响。
