Walker Rowan, Pussell Bruce A
Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Nephrology (Carlton). 2007 Oct;12(5):448-51. doi: 10.1111/j.1440-1797.2007.00802.x.
This study aimed to compare the within-patient variability in haemoglobin levels in haemodialysis patients receiving intravenous epoetin alfa or intravenous darbepoetin alfa. Data on haemodialysis patients were extracted from the Renal Anaemia Management database from 2003 to 2004. The variance in haemoglobin was calculated for each patient with more than five haemoglobin observations (n = 3619). A mixed model was fitted to the within-patient variances and weighting was based on the number of observations minus 1 for each patient. The model took into account the situation where patients had data on both agents and could therefore act as their own control. The mean within-patient variance in haemoglobin levels for patients receiving darbepoetin alfa was 24% (95% CI: 18%, 31%) greater than that for patients receiving epoetin alfa (P < 0.0001). The mean haemoglobin level for patients receiving darbepoetin alfa was 11.33 g/dL (95% CI: 11.27, 11.40) compared with 11.43 g/dL (95% CI: 11.39, 11.46) for patients receiving epoetin alfa (P < 0.01). There was greater within-patient fluctuation in haemoglobin levels in patients receiving darbepoetin alfa compared with epoetin alfa. The implications of haemoglobin fluctuations on patient outcomes and resource use require further study.
本研究旨在比较接受静脉注射阿法依泊汀或静脉注射达比加群酯的血液透析患者血红蛋白水平的患者内变异性。从2003年至2004年的肾性贫血管理数据库中提取血液透析患者的数据。对每位有超过五次血红蛋白观察值的患者（n = 3619）计算血红蛋白的方差。对患者内方差拟合混合模型，并根据每位患者观察值减1的数量进行加权。该模型考虑了患者同时拥有两种药物数据的情况，因此可以作为自身对照。接受达比加群酯的患者血红蛋白水平的平均患者内方差比接受阿法依泊汀的患者高24%（95%CI：18%，31%）（P < 0.0001）。接受达比加群酯的患者的平均血红蛋白水平为11.33 g/dL（95%CI：11.27，11.40），而接受阿法依泊汀的患者为11.43 g/dL（95%CI：11.39，11.46）（P < 0.01）。与阿法依泊汀相比，接受达比加群酯的患者血红蛋白水平的患者内波动更大。血红蛋白波动对患者结局和资源使用的影响需要进一步研究。
