Kotanko Peter, Thijssen Stephan, Levin Nathan W
Renal Research Institute, New York, NY, USA.
Blood Purif. 2008;26(1):82-9. doi: 10.1159/000110571. Epub 2008 Jan 10.
In contrast to the general population, in maintenance hemodialysis (MHD) patients, small body size is correlated with reduced survival. The reasons for this association are unclear but may be related to a lower uremic toxin load relative to body weight and a higher distribution volume for uremic toxins in large patients. Since anemia is a salient feature in dialysis patients, this study aimed to explore the relationship between body composition and anemia control.
Total adipose tissue (TAT), subcutaneous adipose tissue (SAT) and muscle mass (MM) were estimated by regression models in African-American MHD patients. Patients were grouped for further analysis by gender in tertiles of TAT, SAT, and MM. Analysis of covariance with age and serum albumin as covariates was employed to test for differences in hemoglobin (Hgb, g/dl), erythropoietin use (EPO, U/kg b.w./week), and EPO resistance index (ERI, U/kg b.w./week/Hgb).
479 patients were studied (50.5% females). In both genders, EPO dose and ERI were lower the higher the tertile of TAT and SAT (all p < 0.02). In females, EPO and ERI were inversely related to tertiles of MM (p <or= 0.001). No difference in Hgb concentration was observed.
Anemia control is related to body composition in Black dialysis patients. EPO requirements and EPO resistance are reduced in patients with high TAT, SAT and MM (the latter in females only). A lower uremic load in large dialysis patients may contribute to these findings.
与普通人群不同，维持性血液透析（MHD）患者体型较小与生存率降低相关。这种关联的原因尚不清楚，但可能与相对于体重而言较低的尿毒症毒素负荷以及体型较大患者中尿毒症毒素较高的分布容积有关。由于贫血是透析患者的一个显著特征，本研究旨在探讨身体成分与贫血控制之间的关系。
通过回归模型估算非裔美国MHD患者的总脂肪组织（TAT）、皮下脂肪组织（SAT）和肌肉量（MM）。根据TAT、SAT和MM的三分位数按性别对患者进行分组以进行进一步分析。采用以年龄和血清白蛋白作为协变量的协方差分析来检验血红蛋白（Hgb，g/dl）、促红细胞生成素使用量（EPO，U/kg体重/周）和促红细胞生成素抵抗指数（ERI，U/kg体重/周/Hgb）的差异。
共研究了479例患者（50.5%为女性）。在男女两性中，TAT和SAT的三分位数越高，EPO剂量和ERI越低（所有p<0.02）。在女性中，EPO和ERI与MM的三分位数呈负相关（p≤0.001）。未观察到Hgb浓度有差异。
黑人透析患者的贫血控制与身体成分有关。TAT、SAT和MM较高的患者（后者仅在女性中）促红细胞生成素需求和促红细胞生成素抵抗降低。体型较大的透析患者较低的尿毒症负荷可能导致了这些结果。
