Division of Nephrology, S Anna University Hospital, Corso Giovecca 203, 44100 Ferrara, Italy.
BMC Nephrol. 2009 Oct 24;10:33. doi: 10.1186/1471-2369-10-33.
The Italian and European Best Practice Guidelines (EBPG) recommend a target haemoglobin value greater than 11 g/dl in most patients with Chronic Kidney Diseases. However, it is still difficult to maintain these values at a steady rate. Thus, the main aim of the study was to evaluate, throughout 2005, how many patients steadily maintained the performance targets related to anaemia treatment.
The survey was conducted on 3283 patients on haemodialysis (HD) and peritoneal dialysis (PD) at 20 Italian dialysis centres. 540 patients were randomly selected; each centre provided a statistically significant sample proportional to its total number of patients. Maintenance of the following target levels was assessed over time: Haemoglobin (HB) 11-12 gr/dl; Iron: 60-160 mcg/dl; Ferritin: 30-400 mcg/l; Transferrin: 200-360 mg/dl; Transferrin saturation percentage (TSAT %):> 25 <50; Dialysis doses (KT/V): >1.2 <2.0 for non-diabetic HD patients; >1.5 <2.2 for diabetic HD patients; DP: >1.8 <2.5.Outcome included:1- Percentage of target maintenance for each parameter.2- Erythropoietin dose in relation to dialysis techniques, presence of cancer or myeloma, diabetic status, Vitamin B therapy.3- Erythropoietin dose (International Units/kg/week) (IU/kg/wk) depending on: haemoglobin values, hospitalization of more than 3 days.
Mean age was 65.1; mean haemoglobin concentration over the whole population was 11.3 gr/dl (Standard Deviation (SD): 0.91). The clinical performance targets were maintained over time as follows: HB: 4.3% (Mean 11.43 gr/dl) (SD: 0.42); Ferritin: 71.1% (Mean: 250.23 mcg/L (SD:104.07); Iron: 95.0% (Mean 59.79 mcg/dl)(SD:16.76); Transferrin: 44.8% (Mean 216.83 mg/dl) (SD: 19,50); TSAT %: in 8.4% (Mean: 34.33% (SD: 6.56); HD KT/V: 61.0% (Mean:1.46) (SD: 0.7); PD KT/V:31.4% (Mean: 2.10) (SD: 0.02). The average weekly dose of Erythropoietin (IU/Kg/Wk) was significantly lower for the peritoneal dialysis technique; the higher haemoglobin values, the lower the Erythropoietin dose (IU/Kg/Wk).
A very low percentage of patients maintained haemoglobin target values over time. We need to identify precise criteria to evaluate the stability over time of clinical performance targets proposed by the guidelines.
意大利和欧洲最佳实践指南（EBPG）建议大多数慢性肾脏病患者的目标血红蛋白值大于 11g/dl。然而，仍然很难稳定维持这些值。因此，本研究的主要目的是评估在 2005 年期间有多少患者能够稳定地维持与贫血治疗相关的达标情况。
在意大利 20 个透析中心对 3283 名血液透析（HD）和腹膜透析（PD）患者进行了调查。随机选择了 540 名患者；每个中心都根据其患者总数提供了具有统计学意义的比例样本。评估了以下目标水平的维持情况：血红蛋白（HB）11-12g/dl；铁：60-160mcg/dl；铁蛋白：30-400mcg/l；转铁蛋白：200-360mg/dl；转铁蛋白饱和度百分比（TSAT%）：25%<50%；透析剂量（KT/V）：非糖尿病 HD 患者>1.2<2.0；糖尿病 HD 患者>1.5<2.2；PD：>1.8<2.5。结果包括：1. 每个参数的达标维持率。2. 红细胞生成素剂量与透析技术、癌症或骨髓瘤、糖尿病状态、维生素 B 治疗的关系。3. 红细胞生成素剂量（国际单位/千克/周）（IU/kg/wk）取决于：血红蛋白值、住院时间超过 3 天。
平均年龄为 65.1 岁；整个人群的平均血红蛋白浓度为 11.3g/dl（标准差（SD）：0.91）。临床达标情况随时间维持如下：HB：4.3%（平均 11.43g/dl）（SD：0.42）；铁蛋白：71.1%（平均：250.23mcg/L（SD：104.07）；铁：95.0%（平均 59.79mcg/dl）（SD：16.76）；转铁蛋白：44.8%（平均 216.83mg/dl）（SD：19.50）；TSAT%：8.4%（平均：34.33%（SD：6.56）；HD KT/V：61.0%（平均：1.46）（SD：0.7）；PD KT/V：31.4%（平均：2.10）（SD：0.02）。红细胞生成素（IU/Kg/Wk）的平均每周剂量腹膜透析技术明显较低；血红蛋白值越高，红细胞生成素剂量（IU/Kg/Wk）越低。
很少有患者能随时间维持血红蛋白目标值。我们需要确定精确的标准来评估指南中提出的临床达标情况随时间的稳定性。
