Wish J B, Nassar G M, Schulman K, del Aguila M, Provenzano R
Department of Nephrology, Case Western Reserve University, Cleveland, OH 44106, USA.
Clin Nephrol. 2008 Apr;69(4):251-9. doi: 10.5414/cnp69251.
Anemia and cardiovascular (CV) events are major complications of chronic kidney disease (CKD) during dialysis. We conducted a retrospective observational study in CKD patients with anemia to evaluate the association between predialysis use of erythropoiesis-stimulating agents (ESAs) and postdialysis CV outcomes.
The study analyzed claims data on incident hemodialysis patients aged > or = 18 years (identified between January 2000 and November 2005). Patients were identified as anemic and ESA-treated prior to dialysis. ESA treatment was categorized into 4 consistency groups (from least to most consistent ESA use).
Of 5,848 hemodialysis patients, 52% were identified as anemic prior to onset of dialysis. Predialysis ESA treatment was received by 62% of anemic patients, with only 23% receiving the most consistent treatment. The risk of a CV event was significantly lower for the ESA-treated compared with ESA-untreated patients (relative risk (RR) 0.70, 95% (95% confidence intervals (CI) 0.61 - 0.82)). Compared with ESA-untreated, those who received ESAs had significantly lower risk of acute myocardial infarction (RR 0.65 (95% CI 0.44 - 0.95)) or inpatient mortality (RR 0.52 (95% CI 0.40 - 0.68)). ESA-treated patients in each of the 4 consistency groups had significantly lower risk of CV events compared with ESA-untreated patients, with the greatest benefit seen in patients who received most consistent ESA (RR 0.61 (95% CI 0.48 - 0.76)).
This analysis suggests consistent ESA use to treat anemia of CKD in the predialysis period is associated with improved cardiovascular outcomes in postdialysis patients.
贫血和心血管事件是慢性肾脏病（CKD）患者透析期间的主要并发症。我们对患有贫血的CKD患者进行了一项回顾性观察研究，以评估透析前使用促红细胞生成素（ESA）与透析后心血管结局之间的关联。
该研究分析了年龄≥18岁的新发血液透析患者（2000年1月至2005年11月期间确诊）的理赔数据。患者在透析前被确定为贫血且接受ESA治疗。ESA治疗分为4个一致性组（从使用ESA最不一致到最一致）。
在5848例血液透析患者中，52%在透析开始前被确定为贫血。62%的贫血患者接受了透析前ESA治疗，只有23%接受了最一致的治疗。与未接受ESA治疗的患者相比，接受ESA治疗的患者发生心血管事件的风险显著降低（相对风险（RR）0.70，95%（95%置信区间（CI）0.61 - 0.82））。与未接受ESA治疗的患者相比，接受ESA治疗的患者发生急性心肌梗死的风险（RR 0.65（95%CI 0.44 - 0.95））或住院死亡率（RR 0.52（95%CI 0.40 - 0.68））显著降低。4个一致性组中接受ESA治疗的患者与未接受ESA治疗的患者相比，发生心血管事件的风险均显著降低，在接受最一致ESA治疗的患者中获益最大（RR 0.61（95%CI 0.48 - 0.76））。
该分析表明，在透析前期持续使用ESA治疗CKD贫血与改善透析后患者的心血管结局相关。
