Kato Fumino, Takeuchi Noriko, Takenoshita Emi, Yuasa Jyoji, Isaka Shigeo, Fujii Takayuki, Suzuki Satoshi, Irie Yasubumi, Ogawa Makoto, Ueda Shiro
Department of Drug Information and Communication, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba, Japan.
Nihon Jinzo Gakkai Shi. 2010;52(1):58-65.
Renal anemia is a serious complication of chronic kidney disease (CKD) and accelerates its progress. Recombinant human erythropoietin (rHuEPO) therapy not only improves anemia but also has a renoprotective effect. This study aimed to determine whether treatment with rHuEPO can retard the initiation of hemodialysis (HD) in patients with CKD.
Clinical data of CKD patients who had already been treated with HD were analyzed retrospectively. Twenty-one patients who had received rHuEPO therapy constituted the treated group (EPO(+) group), and twenty-one other patients without rHuEPO constituted the non-treated group (EPO(-) group). The study start-point was the day of kidney function deterioration, judged as CKD stage 5. The end-point of the study was the initiation of HD.
During the evaluation period, mean values of hemoglobin (Hb) in the EPO(+) group remained lower than those in the EPO(-) group. Survival analysis limited to the two-year period from the beginning of evaluation showed that the renal survival rate of the EPO(+) group was significantly better than that of the EPO(-) group [EPO(+): 42.1% vs. EPO(-): 12.5%, p<0.05]. Duration of renal survival was 29.8 +/- 4.07 months in the EPO(+) group and 19.1 +/- 3.27 months in the EPO(-) group (p<0.05).
Although the mean values of Hb remained lower in the EPO(+) group than in the EPO(-) group during the observation period, the renal survival rate and duration of renal survival in the EPO(+) group were significantly superior than in the EPO(-) group. The study suggests that rHuEPO exerts a renoprotective effect via a mechanism other than the correction of anemia.
肾性贫血是慢性肾脏病（CKD）的严重并发症，并加速其进展。重组人促红细胞生成素（rHuEPO）治疗不仅可改善贫血，还具有肾脏保护作用。本研究旨在确定rHuEPO治疗是否能延缓CKD患者开始血液透析（HD）的时间。
回顾性分析已接受HD治疗的CKD患者的临床资料。21例接受rHuEPO治疗的患者构成治疗组（EPO(+)组），另外21例未接受rHuEPO治疗的患者构成未治疗组（EPO(-)组）。研究起始点为肾功能恶化之日，判定为CKD 5期。研究终点为开始HD。
在评估期间，EPO(+)组血红蛋白（Hb）的平均值仍低于EPO(-)组。仅限于评估开始后两年的生存分析显示，EPO(+)组的肾脏生存率显著优于EPO(-)组[EPO(+)：42.1%对EPO(-)：12.5%，p<0.05]。EPO(+)组肾脏生存时间为29.8±4.07个月，EPO(-)组为19.1±3.27个月（p<0.05）。
尽管在观察期内EPO(+)组Hb的平均值仍低于EPO(-)组，但EPO(+)组的肾脏生存率和肾脏生存时间显著优于EPO(-)组。该研究表明，rHuEPO通过纠正贫血以外的机制发挥肾脏保护作用。
