Molina M, Navarro M J, Palacios M E, de Gracia M C, García Hernández M A, Ríos Moreno F, Pérez Silva F M
Nefrología, Hospital Santa María del Rosell.
Nefrologia. 2007;27(2):196-201.
Chronic inflammatory diseases and infections are a major cause of hyporesponse to erythropoiesis-stimulating factors. We conducted this prospective study in 107 patients in haemodialysis with dialysis liquid that was potentially contaminated from a bacteriological perspective in order to test the hypothesis that ultrapure dialysis liquid can improve the response to treatment with darbepoetin and reduce inflammatory markers. These patients had to have been stable in the last 8 weeks in relation to haemoglobin level and the administered dose of darbepoetin. Two filters (one of hydrophilic nylon and another of polysulfone) were added to the water treatment process, the first one prior to distribution ring output and the second before the dialyser. The patients were evaluated for 12 months. The dosage of darbepoetin was varied to maintain haemoglobin levels ranging from 11 to 14 g/dl. We measured resistance to the erythropoiesis-stimulating factor, defined as the quotient between weekly dose of darbepoetin and haemoglobin levels, baseline and every two months, the baseline and monthly endotoxin count and reactive protein C at baseline and every 6 months. 94 patients completed the study. The resistance index fell significantly during follow-up (p<0.001) and was measurable from the second month on. Haemoglobin levels remained within the established margins with a 34% reduction in the weekly dose of darbepoetin at the end of the follow-up period. Both reactive protein C and the endotoxin count were significantly reduced (p<0.001) compared to baseline after 6 and 12 months. To conclude, the bacteriological purity of the dialysis liquid reduces inflammatory markers in patients receiving haemodialysis, improving the response to treatment with darbepoetin in renal anaemia.
慢性炎症性疾病和感染是促红细胞生成素刺激因子反应低下的主要原因。我们对107例接受血液透析的患者进行了这项前瞻性研究，这些患者的透析液从细菌学角度来看可能受到污染，目的是检验超纯透析液能否改善对达比泊汀治疗的反应并降低炎症标志物这一假设。这些患者在过去8周内血红蛋白水平和达比泊汀给药剂量必须保持稳定。在水处理过程中添加了两个过滤器（一个是亲水性尼龙过滤器，另一个是聚砜过滤器），第一个在分配环输出之前，第二个在透析器之前。对患者进行了12个月的评估。调整达比泊汀的剂量以维持血红蛋白水平在11至14 g/dl之间。我们测量了对促红细胞生成素刺激因子的抵抗性，定义为达比泊汀每周剂量与血红蛋白水平的商，在基线时以及每两个月测量一次，在基线时以及每6个月测量一次内毒素计数和反应性蛋白C。94例患者完成了研究。随访期间抵抗指数显著下降（p<0.001），从第二个月开始即可测量。血红蛋白水平保持在既定范围内，随访期结束时达比泊汀每周剂量减少了34%。与基线相比，6个月和12个月后反应性蛋白C和内毒素计数均显著降低（p<0.001）。总之，透析液的细菌学纯度可降低接受血液透析患者的炎症标志物，改善肾性贫血对达比泊汀治疗的反应。
