Division of Nephrology and Hypertension, Los Angeles Biomedical Research Center at Harbor-UCLA Medical Center, 1124 West Carson Street, C1-Annex, Torrance, California 90502, USA.
Clin J Am Soc Nephrol. 2011 Aug;6(8):1973-81. doi: 10.2215/CJN.01050211. Epub 2011 Jul 22.
Interventional trials and some observational studies show target hemoglobin >13 g/dl to be associated with higher mortality in erythropoiesis-stimulating agent-treated (ESA-treated) hemodialysis patients; data for peritoneal dialysis (PD) patients are limited.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We tested our hypothesis that higher and lower achieved hemoglobin levels are associated with increased mortality in 9269 ESA-treated PD patients from all DaVita dialysis clinics during the time period July 2001 through June 2006 followed through June 2007 using a time-dependent analysis.
Lower hemoglobin was associated with significantly higher all-cause mortality in ESA-treated PD patients: with hemoglobin of 11.0 to <12.0 g/dl as reference, the time-dependent adjusted death hazard ratios for hemoglobin levels of 10.0 to <11.0, 9.0 to <10.0, and ≤9.0 g/dl were 1.12 (1.00 to 1.24), 1.30 (1.12 to 1.50), and 1.38 (1.14 to 1.67), respectively. The time-dependent adjusted hazard ratios for cardiovascular death with hemoglobin levels of 10.0 to <11.0, 9.0 to <10.0, and ≤9.0 g/dl were 1.11 (0.93 to 1.32), 1.37 (1.09 to 1.72), and 1.12 (0.79 to 1.57), respectively. The same trend for association of lower hemoglobin level with higher mortality was seen in African-American and non-African American men and women. In contrast, there was no association between higher achieved hemoglobin and all-cause or cardiovascular mortality in ESA-treated PD patients.
Lower, but not higher, achieved hemoglobin is associated with higher mortality in ESA-treated PD patients. Randomized controlled trials are needed to examine the target hemoglobin level with lowest mortality in PD patients.
干预性试验和一些观察性研究表明，接受促红细胞生成素治疗（ESA 治疗）的血液透析患者的目标血红蛋白值>13 g/dl 与更高的死亡率相关；而腹膜透析（PD）患者的数据有限。
设计、设置、参与者和测量方法：我们通过时间依赖性分析，检验了我们的假设，即 ESA 治疗的 PD 患者中，较低和较高的血红蛋白水平与死亡率增加相关。该研究纳入了 2001 年 7 月至 2006 年 6 月期间所有 DaVita 透析诊所的 9269 名接受 ESA 治疗的 PD 患者，随访至 2007 年 6 月。
在接受 ESA 治疗的 PD 患者中，较低的血红蛋白与全因死亡率显著相关：以血红蛋白 11.0 至<12.0 g/dl 为参考，血红蛋白水平为 10.0 至<11.0、9.0 至<10.0 和≤9.0 g/dl 的时间依赖性调整死亡风险比分别为 1.12（1.00 至 1.24）、1.30（1.12 至 1.50）和 1.38（1.14 至 1.67）。血红蛋白水平为 10.0 至<11.0、9.0 至<10.0 和≤9.0 g/dl 的心血管死亡时间依赖性调整风险比分别为 1.11（0.93 至 1.32）、1.37（1.09 至 1.72）和 1.12（0.79 至 1.57）。在非裔美国男性和女性以及非非裔美国男性和女性中，较低的血红蛋白水平与更高的死亡率之间也存在同样的关联趋势。相比之下，在接受 ESA 治疗的 PD 患者中，较高的血红蛋白水平与全因或心血管死亡率之间没有关联。
在接受 ESA 治疗的 PD 患者中，较低的血红蛋白水平与死亡率增加相关，但较高的血红蛋白水平与死亡率增加无关。需要进行随机对照试验来研究 PD 患者的最低死亡率目标血红蛋白水平。
