Fernández Fresnedo G, de Francisco A L M, Ruiz J C, Gómez Alamillo C, Arias M
Nephrology Service, University Hospital Marqués de Valdecilla, Santander, Spain.
Transplant Proc. 2008 Nov;40(9):2919-21. doi: 10.1016/j.transproceed.2008.08.093.
Treatment with erythropoiesis stimulating agents (ESA) is associated with fluctuations in hemoglobin (Hb) levels. Recently, variability of Hb has been considered a factor that influences comorbidity and mortality among hemodialysis patients. The purpose of this analysis was to describe the phenomenon of Hb variability during ESA treatment, to study associated factors among kidney transplant patients, and to assess the impact on patient and graft survivals.
Hb variability (defined as fluctuations of Hb +/- 1.5 g/dL) was assessed in 85 renal transplant patients treated with ESA for at least 3 months and with a minimum of 6 Hb measurements during 1 year.
Fifty-eight percent of the patients experienced Hb variability during follow-up. Only 3% of patients maintained stable Hb levels within the target range (11-13 g/dL), although 83% of patients maintained Hb levels >11 g/dL. Multivariate analysis showed that the clinical factors associated with variability were changes in ESA dose (relative risk [RR]: 2.92; 95% confidence interval [CI]: 1.0-8.5; P < .05), infectious events with hospitalization (RR: 1.95; 95% CI: 1.23-2.13; P < .05), and the use of sirolimus (RR: 1.1; 95% CI: 1.0-3.6; P < .05). When dose changes and hospitalization were excluded from the analysis, variability was an independent predictor of worsening graft function.
Hb variability is common in renal transplant patients treated with ESA. Only a few patients maintained Hb levels within the therapeutic range, although most had levels >11g/dL. Dose changes, inflammatory status, and worsening graft function are the determining factors of variability. Variability had no influence on patient survival, although it was a marker of worsening graft function.
促红细胞生成素（ESA）治疗与血红蛋白（Hb）水平波动相关。近来，Hb变异性被视为影响血液透析患者合并症及死亡率的一个因素。本分析的目的是描述ESA治疗期间Hb变异性现象，研究肾移植患者的相关因素，并评估其对患者及移植物存活的影响。
对85例接受ESA治疗至少3个月且在1年内至少进行6次Hb测量的肾移植患者评估Hb变异性（定义为Hb波动±1.5 g/dL）。
58%的患者在随访期间出现Hb变异性。仅3%的患者Hb水平维持在目标范围内（11 - 13 g/dL）且保持稳定，尽管83%的患者Hb水平>11 g/dL。多因素分析显示，与变异性相关的临床因素包括ESA剂量变化（相对危险度[RR]：2.92；95%置信区间[CI]：1.0 - 8.5；P < 0.05）、因感染事件住院（RR：1.95；95% CI：1.23 - 2.13；P < 0.05）以及使用西罗莫司（RR：1.1；95% CI：1.0 - 3.6；P < 0.05）。当分析中排除剂量变化和住院因素时，变异性是移植物功能恶化的独立预测因素。
接受ESA治疗的肾移植患者中Hb变异性很常见。仅有少数患者Hb水平维持在治疗范围内，尽管大多数患者Hb水平>11 g/dL。剂量变化、炎症状态及移植物功能恶化是变异性的决定因素。变异性对患者存活无影响，尽管它是移植物功能恶化的一个标志。
