Division of Nephrology, Second University of Naples, Naples, Italy.
Nephrol Dial Transplant. 2012 Jul;27(7):2880-6. doi: 10.1093/ndt/gfs007. Epub 2012 Feb 8.
Lower responsiveness to erythropoiesis-stimulating agents (ESA-R) predicts cardiovascular (CV) events. Whether ESA-R also affects the risk of end-stage renal disease (ESRD) is unknown.
We evaluated ESA-R in 194 consecutive chronic kidney disease (CKD) patients, regularly seen in outpatient nephrology clinics, who started erythropoiesis-stimulating agent (ESA) therapy between 2002-06. Exclusion criteria were causes of anaemia other than CKD or recent transfusion. ESA-R was calculated as (Hb1-Hb0)/time/ESA dose (g/dL/month/10 μg/week of ESA). Patients were classified, from lower to higher tertile of ESA-R, as poor, intermediate and good responders. Time to ESRD was the primary outcome.
Age was 64±16 years, 48% were male, 34% had diabetes and 32% had CV disease, glomerular filtration rate (GFR) 24±13 mL/min/1.73 m2 and proteinuria 0.6 g/dL (interquartile range 0.2-1.9). First ESA dose was 23.7±10.8 μg/week; haemoglobin (Hb) increased from 9.9±0.8 g/dL to 11.0±1.2 g/dL at first control, obtained after 1.4±0.4 months. These changes corresponded to an ESA-R of 0.37±0.38 g/dL/month/10 μg/week of ESA and tertiles limits were 0.17 and 0.47. Poor responders were younger and had lower GFR and higher proteinuria than intermediate and good responders. During the first 6 months of ESA therapy, poor responders showed lower Hb levels and sustained longer periods of Hb level<11 g/dL. During follow-up (median 3.0 years), 99 patients reached ESRD. At multivariable Cox's analysis, poor responsiveness was associated with higher risk of ESRD (hazard ratio 2.49, 95% confidence interval 1.28-4.84).
ESA-R predicts renal prognosis in CKD patients followed in nephrology practice, where ESRD is the predominant outcome and ESA is commonly used at low dose.
对红细胞生成刺激剂（ESA）反应较低（ESA-R）可预测心血管（CV）事件。但是，ESA-R 是否也会影响终末期肾病（ESRD）的风险尚不清楚。
我们评估了 194 例连续的慢性肾脏病（CKD）患者，这些患者定期在门诊肾脏科诊所就诊，他们于 2002-06 年期间开始使用红细胞生成刺激剂（ESA）治疗。排除标准为除 CKD 以外的其他贫血原因或近期输血。ESA-R 计算为（Hb1-Hb0）/时间/ESA 剂量（g/dL/月/ESA 剂量为 10 μg/周）。根据 ESA-R 的三分位数（从低到高），将患者分为反应差、反应中等和反应良好的患者。ESRD 是主要结局。
年龄为 64±16 岁，48%为男性，34%患有糖尿病，32%患有 CV 疾病，肾小球滤过率（GFR）为 24±13 mL/min/1.73 m2，蛋白尿为 0.6 g/dL（四分位距 0.2-1.9）。首次 ESA 剂量为 23.7±10.8 μg/周；血红蛋白（Hb）从 9.9±0.8 g/dL 增加到 11.0±1.2 g/dL，在首次控制后 1.4±0.4 个月获得。这些变化对应于 ESA-R 为 0.37±0.38 g/dL/月/ESA 剂量为 10 μg/周，三分位数的限值为 0.17 和 0.47。反应差的患者比反应中等和反应良好的患者年轻，GFR 较低，蛋白尿较高。在 ESA 治疗的最初 6 个月中，反应差的患者 Hb 水平较低，并且 Hb 水平<11 g/dL 的持续时间更长。在随访期间（中位数为 3.0 年），有 99 例患者达到 ESRD。在多变量 Cox 分析中，反应差与 ESRD 的风险增加相关（风险比 2.49，95%置信区间 1.28-4.84）。
在肾脏科实践中随访的 CKD 患者中，ESA-R 可预测肾脏预后，其中 ESRD 是主要结局，ESA 通常以低剂量使用。
