Walker Rowan, Pussell Bruce A
Department of Nephrology and North West Dialysis Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Nephrology (Carlton). 2009 Oct;14(7):689-95. doi: 10.1111/j.1440-1797.2009.01166.x.
To characterize the haemoglobin variability of haemodialysis, peritoneal dialysis and pre-dialysis patients treated with either epoetin alpha or darbepoetin alpha in a clinical setting where treatment was administered according to current standard Australian practice.
Data on haemodialysis, pre-dialysis and peritoneal dialysis patients were extracted from the Renal Anaemia Management database (RAM) from 1 January 2001 to 31 December 2004. The variance in haemoglobin was calculated from patient records with more than five haemoglobin observations over a period of at least 4 weeks following 9 weeks of therapy. A mixed-model was fitted to the within-patient variances and weighting was based on the number of observations minus 1 for each record.
The mean within-patient variance in haemoglobin levels for i.v. administered erythropoietin-stimulating agents (IV) haemodialysis, s.c. administered erythropoietin-stimulating agents (SC) haemodialysis, predialysis (SC) and peritoneal dialysis (SC) patients receiving epoetin alpha were 9% (95% CI: 13% to 5%, P < 0.0001), 17% (95% CI: 32% to 0.2%, P = 0.047), 19% (95% CI: 27% to 11%, P < 0.0001) and 26% (95% CI: 33% to 18%, P < 0.0001) lower than that for patients receiving darbepoetin alpha. The mean haemoglobin levels for haemodialysis (IV), haemodialysis (sc) predialysis (SC) and peritoneal dialysis (SC) patients receiving darbepoetin alpha were 11.6 g/dL, 11.2 g/dL, 11.5 g/dL and 11.5 g/dL compared with 11.5 g/dL, 11.6 g/dL, 11.7 g/dL and 11.5 g/dL for patients receiving epoetin alpha.
There was 9-26% greater within-patient fluctuation in haemoglobin levels in patients receiving darbepoetin alpha compared with epoetin alpha. The causes of haemoglobin fluctuations and the implications for patient outcomes and resource use require further study.
在按照澳大利亚现行标准进行治疗的临床环境中，对接受α-促红细胞生成素或α-达比泊汀治疗的血液透析、腹膜透析及透析前患者的血红蛋白变异性进行特征描述。
从肾脏贫血管理数据库（RAM）中提取2001年1月1日至2004年12月31日期间血液透析、透析前及腹膜透析患者的数据。血红蛋白的方差根据治疗9周后至少4周内有超过5次血红蛋白观察值的患者记录计算得出。对患者内方差拟合混合模型，权重基于每条记录的观察次数减1。
接受α-促红细胞生成素的静脉注射促红细胞生成素刺激剂（IV）血液透析、皮下注射促红细胞生成素刺激剂（SC）血液透析、透析前（SC）及腹膜透析（SC）患者血红蛋白水平的患者内平均方差分别为9%（95%CI：13%至5%，P<0.0001）、17%（95%CI：32%至0.2%，P = 0.047）、19%（95%CI：27%至11%，P<0.0001）和26%（95%CI：33%至18%，P<0.0001），低于接受α-达比泊汀的患者。接受α-达比泊汀的血液透析（IV）、血液透析（sc）、透析前（SC）及腹膜透析（SC）患者的平均血红蛋白水平分别为11.6 g/dL、11.2 g/dL、11.5 g/dL和11.5 g/dL，而接受α-促红细胞生成素的患者分别为11.5 g/dL、11.6 g/dL、11.7 g/dL和11.5 g/dL。
与α-促红细胞生成素相比，接受α-达比泊汀的患者血红蛋白水平的患者内波动大9%-26%。血红蛋白波动的原因及其对患者预后和资源利用的影响需要进一步研究。
