Division of Nephrology and Hypertension, Department of Medicine, UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Division of Nephrology and Hypertension, Department of Medicine, UNC Kidney Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Kidney Int. 2011 Nov;80(9):992-999. doi: 10.1038/ki.2011.247. Epub 2011 Aug 17.
African-American patients with end-stage renal disease have historically lower hemoglobin concentrations and higher requirements of erythropoiesis-stimulating agent (ESA). While disparities in health-care access may partially explain these findings, the role of variant hemoglobin, such as sickle trait, has not been investigated. To clarify this, we evaluated 154 African-American patients receiving in-center hemodialysis with available hemoglobin phenotyping. The primary exposure was any abnormal hemoglobin variant and the primary outcome of higher-dose ESA was defined as a dose of 6500 or more units per treatment. Logistic regression assessed the association between variant hemoglobin and higher-dose ESA. Covariates included age, gender, diabetes, iron parameters, intravenous iron dose, parathyroid hormone, albumin, phosphorus, body mass index, vascular access type, hospitalization/missed treatments, smoking status, alcohol abuse, and gastrointestinal bleeding. Of 33 patients with variant hemoglobin, 24 had HbAS and 9 had HbAC. Univariate odds of higher-dose ESA among those with hemoglobin variants were twice that of those with the normal HbAA phenotype (odds ratio 2.05). In multivariate models, the likelihood of higher-dose ESA had an odds ratio of 3.31 and the nature of this relationship did not change in Poisson regression or sensitivity analyses. Hence, our findings may explain, in part, the difference in ESA dosing between Caucasians and African-Americans with end-stage renal disease but await further study.
非洲裔美国终末期肾病患者的血红蛋白浓度历来较低，促红细胞生成素刺激剂（ESA）的需求量较高。虽然医疗保健机会的差异可能部分解释了这些发现，但变异血红蛋白（如镰状细胞特征）的作用尚未得到调查。为了阐明这一点，我们评估了 154 名接受中心血液透析且有可用血红蛋白表型的非洲裔美国患者。主要暴露因素是任何异常血红蛋白变异体，高剂量 ESA 的主要结果定义为每次治疗使用 6500 个或更多单位的 ESA。逻辑回归评估了变异血红蛋白与高剂量 ESA 之间的关联。协变量包括年龄、性别、糖尿病、铁参数、静脉铁剂量、甲状旁腺激素、白蛋白、磷、体重指数、血管通路类型、住院/漏诊治疗、吸烟状况、酒精滥用和胃肠道出血。在 33 名有变异血红蛋白的患者中，24 名有 HbAS，9 名有 HbAC。与正常 HbAA 表型相比，血红蛋白变异体患者使用高剂量 ESA 的单变量优势比是其两倍（优势比 2.05）。在多变量模型中，高剂量 ESA 的可能性具有 3.31 的优势比，并且这种关系在泊松回归或敏感性分析中没有改变。因此，我们的发现可能部分解释了终末期肾病的白种人和非洲裔美国人之间 ESA 剂量差异，但仍需进一步研究。
