Santos Paulo Roberto, Melo Antonio Danilo Mourão, Lima Monique Marie Brito Cortez, Negreiros Idalina Maria A Holanda, Miranda Jéssica Silva, Pontes Larissa Salles, Rabelo Guilherme Menezes, Viana Ana Carolina Parente, Alexandrino Mayara Teixeira, Barros Francisco Anderson, Neto Benjamin Ramos, Brito Alana Alcântara, Da Silva Costa Anderson
Sobral School of Medicine, Federal University of Ceará, Sobral, Brazil.
Hemodial Int. 2011 Oct;15(4):493-500. doi: 10.1111/j.1542-4758.2011.00607.x. Epub 2011 Sep 9.
There is no consensus about the toxicity of erythropoiesis-stimulating agents among hemodialysis patients. We aimed to calculate the risk of death according to anemia control and erythropoietin (EPO) dosing among end-stage renal disease patients undergoing hemodialysis. We retrospectively studied 156 end-stage renal disease patients on hemodialysis from a single renal unit during 12 months. Participants were classified according to anemia control into four groups: excellent (A), good (B), moderate (C) and bad (D) control. They were also classified according to EPO dosing into two groups: usual and high EPO dosing. The Cox proportional hazards regression model, adjusted for the difference in age, sex, time on dialysis, comorbidity, albumin, and Kt/V index, was performed to calculate the risk of death according to anemia control and EPO dosing profiles. Multivariate analysis by backward stepwise logistic regression was used to calculate the risk of death according to the variables that differed in the comparison between survivors and nonsurvivors. The hazard ratio of death was not significant according to anemia control profile C/D vs. A/B, but hazard ratio was 2.967 (95% confidence interval [CI] = 1.132-7.777; P = 0.027) for high EPO dosing profile patients. The multivariate analysis showed comorbidity (odds ratio [OR] = 8.958; 95% CI = 2.843-26.223; P < 0.001], high EPO dosing profile (OR = 5.172; 95% CI = 1.663-16,081; P = 0.005), age (OR = 1.056; 95% CI = 1.020-1.094; P = 0.002), and mean hemoglobin (OR = 0.435; 95% CI = 0.267-0.709; P = 0.001) to be predictive of death. Even though we cannot conclude that mortality risk is due to EPO toxicity, hemodialysis patients using high EPO dosing must be seen as at risk.
对于血液透析患者中促红细胞生成素的毒性，目前尚无共识。我们旨在计算接受血液透析的终末期肾病患者中，根据贫血控制情况和促红细胞生成素（EPO）剂量的死亡风险。我们回顾性研究了来自单个肾脏单位的156例接受血液透析的终末期肾病患者，为期12个月。参与者根据贫血控制情况分为四组：优秀（A）、良好（B）、中等（C）和差（D）控制。他们还根据EPO剂量分为两组：常规和高EPO剂量。采用Cox比例风险回归模型，对年龄、性别、透析时间、合并症、白蛋白和Kt/V指数的差异进行校正，以根据贫血控制情况和EPO剂量分布计算死亡风险。通过向后逐步逻辑回归进行多变量分析，以根据幸存者和非幸存者之间比较中不同的变量计算死亡风险。根据贫血控制情况C/D与A/B相比，死亡风险比不显著，但高EPO剂量组患者的风险比为2.967（95%置信区间[CI]=1.132-7.777；P=0.027）。多变量分析显示合并症（比值比[OR]=8.958；95%CI=2.843-26.223；P<0.001）、高EPO剂量组（OR=5.172；95%CI=1.663-16.081；P=0.005）、年龄（OR=1.056；95%CI=1.020-1.094；P=0.002）和平均血红蛋白（OR=0.435；95%CI=0.267-0.709；P=0.001）可预测死亡。尽管我们不能得出死亡风险是由于EPO毒性的结论，但使用高剂量EPO的血液透析患者必须被视为有风险。
