Thilly Nathalie, Stengel Bénédicte, Boini Stéphanie, Villar Emmanuel, Couchoud Cécile, Frimat Luc
Department of Clinical Epidemiology and Evaluation, CEC-CIE6 Inserm, University Hospital of Nancy, EA4003, Nancy University, Nancy, France.
Nephron Clin Pract. 2008;108(1):c67-74. doi: 10.1159/000112914. Epub 2008 Jan 8.
Inadequate anaemia correction (haemoglobin (Hb) <11 g/dl without receiving an erythropoiesis-stimulating agent (ESA) is common in pre-dialysis patients, but little is known about its determinants. We used data from the French end-stage renal disease (ESRD) registry to investigate these determinants and the patients' anaemia status 1 year after starting dialysis.
Pre-dialysis anaemia care was studied in 6,271 incident ESRD patients from 13 regions, who were first treated between 2003 and 2005. Data included pre-dialysis Hb measure and ESA use, patient's condition and modalities of dialysis initiation. Anaemia status at 1 year was studied in 925 patients from four regions who started dialysis in 2003 and 2004, were still on dialysis one year later, and had completed the annual registry data form.
Overall, 34.7% of the patients had inadequate pre-dialysis anaemia correction, with variations across regions from 21.1 to 43.2%. Inadequate anaemia correction decreased from 38.0% in 2003 to 33.2% in 2005. It was less likely in patients with diabetic or polycystic kidney disease and more likely in those with malignancy, unplanned haemodialysis, and low glomerular filtration rate or low serum albumin at dialysis initiation. One year after starting dialysis, inadequate correction concerned only 2.6% of the patients. Hb level had risen from 10.3 g/dl in pre-dialysis to 11.7 g/dl, but remained lower in those with inadequate pre-dialysis correction.
Despite improvement over time, inadequate correction with ESAs remains high in pre-dialysis patients in contrast with those on dialysis. As the timing of dialysis initiation is uncertain, continuous management of anaemia is requested.
在透析前患者中，贫血纠正不足（血红蛋白（Hb）<11 g/dl且未接受促红细胞生成素（ESA）治疗）很常见，但对其决定因素知之甚少。我们利用法国终末期肾病（ESRD）登记处的数据来研究这些决定因素以及开始透析1年后患者的贫血状况。
对来自13个地区的6271例初发ESRD患者的透析前贫血护理情况进行了研究，这些患者于2003年至2005年间首次接受治疗。数据包括透析前Hb测量值和ESA使用情况、患者状况以及透析开始方式。对来自4个地区的925例患者的1年贫血状况进行了研究，这些患者于2003年和2004年开始透析，1年后仍在透析，并填写了年度登记数据表。
总体而言，34.7%的患者透析前贫血纠正不足，各地区差异为21.1%至43.2%。贫血纠正不足率从2003年的38.0%降至2005年的33.2%。糖尿病或多囊肾病患者贫血纠正不足的可能性较小，而恶性肿瘤、非计划血液透析以及透析开始时肾小球滤过率低或血清白蛋白低的患者贫血纠正不足的可能性较大。开始透析1年后，贫血纠正不足的患者仅占2.6%。Hb水平已从透析前的10.3 g/dl升至11.7 g/dl，但透析前贫血纠正不足的患者Hb水平仍较低。
尽管随着时间推移有所改善，但与透析患者相比，透析前患者使用ESA进行贫血纠正不足的情况仍然很高。由于透析开始时间不确定，因此需要对贫血进行持续管理。
