Nissenson Allen R, Dylan Michelle L, Griffiths Robert I, Yu Hsing-Ting, Dubois Robert W
David Geffen School of Medicine, University of California Los Angeles, 200 UCLA Medical Plaza, Suite 565-57, Los Angeles, CA 90095, USA.
Clin J Am Soc Nephrol. 2006 May;1(3):505-10. doi: 10.2215/CJN.01150905. Epub 2006 Mar 22.
Septicemia, a common complication in chronic dialysis patients, may be an important factor in erythropoietin (EPO) hyporesponsiveness, because it is a form of inflammation. The quantitative impact of septicemia on EPO requirements has not been studied. The purpose of this study was to analyze patterns of EPO use and levels of anemia among patients who had ESRD and were hospitalized with septicemia. Using United States Renal Data System data, septicemia admissions were identified in patients with first ESRD service from 1996 to 2001. Mean EPO dosage and hematocrit (Hct) level were analyzed from 2 mo before until 3 mo after admission and compared with patients who were hospitalized with acute myocardial infarction (AMI) and patients with no hospitalizations. A total of 4640 hospitalized patients were included in the analysis: 3975 for septicemia and 665 for AMI. In both groups, mean Hct declined significantly in the month of admission and increased in the second month after admission. At all time points, both groups had significantly lower Hct levels compared with the nonhospitalized group. Mean EPO dosage increased, most rapidly in the month after admission. EPO use was highest in the septicemia group. Hospitalization with septicemia is associated with worsening anemia and increasing EPO use. This also was observed for patients who were hospitalized with AMI, suggesting that acute intercurrent illness plays an important role in EPO hyporesponsiveness. Strategies to prevent septicemia are important not only to decrease clinical morbidity but also to conserve EPO usage and thus contain the costs of care for this complex patient population.
败血症是慢性透析患者常见的并发症，可能是促红细胞生成素（EPO）低反应性的一个重要因素，因为它是一种炎症形式。败血症对EPO需求量的定量影响尚未得到研究。本研究的目的是分析终末期肾病（ESRD）且因败血症住院患者的EPO使用模式和贫血水平。利用美国肾脏数据系统的数据，在1996年至2001年首次接受ESRD治疗的患者中识别出败血症住院病例。分析了入院前2个月至入院后3个月的平均EPO剂量和血细胞比容（Hct）水平，并与急性心肌梗死（AMI）住院患者和未住院患者进行比较。共有4640例住院患者纳入分析：3975例败血症患者和665例AMI患者。两组患者在入院当月平均Hct均显著下降，入院后第二个月升高。在所有时间点，两组患者的Hct水平均显著低于未住院组。平均EPO剂量增加，入院后第一个月增加最快。败血症组的EPO使用量最高。败血症住院与贫血加重和EPO使用增加有关。AMI住院患者也观察到这种情况，表明急性并发疾病在EPO低反应性中起重要作用。预防败血症的策略不仅对降低临床发病率很重要，而且对节约EPO使用从而控制这类复杂患者群体的护理成本也很重要。
