Gentil M A, Pérez-Valdivia M A, González-Roncero F M, López-Mendoza M, Cabello V, Bernal G, Suñer M, Pereira P
Nephrology Unit, Hospital Virgen del Rocío, Seville, Spain.
Transplant Proc. 2008 Nov;40(9):2916-8. doi: 10.1016/j.transproceed.2008.08.084.
The CREATE and CHOIR studies showed a higher risk for cardiovascular events associated with hemoglobin (Hb) values >13 g/dL in patients with stage 3-4 chronic kidney disease. In 2007, a stricter policy on the use of erythropoietin (EPO) was adopted at our center, with an Hb target of 11 to 12 g/dL and withdrawal or reduction of EPO when Hb was >12.5 to 13 g/dL. This study was designed to evaluate this new approach.
The study included patients under follow-up at the transplant outpatient clinic on December 31, 2006 (n = 725), and December 31, 2007 (n = 768). Data were compared between the study populations concerning renal function, Hb, use of EPO, and associated costs.
No significant differences in creatinine or Hb values were observed between the 2 groups (1.47 +/- 0.6 vs 1.42 +/- 0.9 mg/dL and 13.7 +/- 1.5 vs 13.7 +/- 1.6 g/dL, respectively). After implementation of the new protocol, the frequency of severe anemia (Hb <11 g/dL) increased (2% vs 4%; P = .10), the use of EPO decreased (22.1% vs 17.2%; P = .017), and the mean Hb of EPO-treated patients decreased (12.5 +/- 1.4 vs 11.9 +/- 1.0; P < .001). The Hb target (11-12 g/dL) was met in fewer than one third of patients, with no significant differences between the 2 study times.
A strict policy on EPO application reduces its use and the rate of patients with "excessive" Hb values (which are associated with increased cardiovascular risks), with an acceptable slight increase in severe anemia cases.
CREATE和CHOIR研究表明，3 - 4期慢性肾病患者中，血红蛋白（Hb）值>13 g/dL与心血管事件风险较高相关。2007年，我们中心采用了更严格的促红细胞生成素（EPO）使用政策，将Hb目标设定为11至12 g/dL，当Hb>12.5至13 g/dL时停用或减少EPO。本研究旨在评估这种新方法。
该研究纳入了2006年12月31日（n = 725）和2007年12月31日（n = 768）在移植门诊接受随访的患者。比较了研究人群之间关于肾功能、Hb、EPO使用及相关费用的数据。
两组之间肌酐或Hb值无显著差异（分别为1.47±0.6 vs 1.42±0.9 mg/dL和13.7±1.5 vs 13.7±1.6 g/dL）。新方案实施后，严重贫血（Hb<ll g/dL）的发生率增加（2% vs 4%；P = 0.10），EPO的使用减少（22.1% vs 17.2%；P = 0.017），接受EPO治疗患者的平均Hb降低（12.5±1.4 vs 11.9±1.0；P<0.001）。不到三分之一的患者达到了Hb目标（11 - 12 g/dL），两个研究时间点之间无显著差异。
严格的EPO应用政策减少了其使用以及“过高”Hb值（与心血管风险增加相关）患者的比例，严重贫血病例有可接受的轻微增加。
