Florit E A, Hadad F, Rodriguez Cubillo B, De la Flor J C, Valga F, Perez Flores I, Calvo Romero N, Valero San Cecilio R, Barrientos Guzman A, Sanchez Fructuoso A
Hospital Clinico San Carlos, Madrid, Spain.
Transplant Proc. 2012 Nov;44(9):2590-2. doi: 10.1016/j.transproceed.2012.09.044.
To study the association between hemoglobin, endogenous erythropoietin (EPO) levels and ferric parameters in kidney recipients not treated with EPO-stimulating agents.
Transverse study of 219 kidney transplant outpatients. The median time after transplantation was 54 months (P(25-75), 23-107). We assessed blood counts, ferric parameters, EPO levels, renal function (MDRD-4), and adjuvant treatment. We performed a linear regression analysis to predict hemoglobin.
Median EPO values were 14.05 mUI/mL (P(25-75) = 10.2-19.7). Applying the formulas described by Beguin, kidney transplant recipients showed a low observed/expected ratio of erythropoietin and of transferrin. Considering anemia to be an hemoglobin of < 12 g/dL in women and < 13 g/dL in men, 24.2% of subjects were anemic (n = 53), including 2.3% with hemoglobin < 11 g/dL. Anemic patients displayed worse renal function (49.2 ± 18.5 versus 55.46 ± 16.58 mL/min/1.73 m(2) in nonanemic; P = .021). There were no differences in C-reactive protein. The patients receiving a combination of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) showed the highest prevalence of anemia compared with other groups (42.9%, P = .027). EPO levels were significantly lower among patients treated with these drugs (P = .041), without differences in transferrin and ferritin. The percentage of anemic patients treated with mammalian target of rapamycin inhibitors (mTORi) was 31% versus 22.2% among those not receiving these immunosuppressants (P = .23). Although there were no differences in hemoglobin levels, patients treated with mTORi, showed higher EPO levels (P = .005) and lower mean corpuscular volume (P < .001). Regarding the etiology of chronic kidney disease, less frequently anemic patients were those with polycystic kidney disease (8.6% versus 26.7% in the rest, P = .021). The formula obtained by multiple linear regression to calculate hemoglobin was: hemoglobin = 11829-0909 log (EPG level) - 0455 (if female) + 0.010 0.013 transferrin + 0.013 creatinine clearance (r = .424, P < .001).
Treatment with ACEI and/or ARBs seemed to produce a defect in the synthesis of EPO, while those treated with mTORi, a hyporesponsive state.
研究未接受促红细胞生成素（EPO）刺激剂治疗的肾移植受者血红蛋白、内源性EPO水平与铁参数之间的关联。
对219例肾移植门诊患者进行横向研究。移植后的中位时间为54个月（P(25 - 75)，23 - 107）。我们评估了血细胞计数、铁参数、EPO水平、肾功能（MDRD-4）及辅助治疗。我们进行线性回归分析以预测血红蛋白。
EPO中位值为14.05 mUI/mL（P(25 - 75)=10.2 - 19.7）。应用贝甘描述的公式，肾移植受者的促红细胞生成素和转铁蛋白观察值/预期值比值较低。将女性血红蛋白<12 g/dL、男性血红蛋白<13 g/dL视为贫血，24.2%的受试者贫血（n = 53），其中2.3%的患者血红蛋白<11 g/dL。贫血患者的肾功能较差（非贫血患者为55.46±16.58 mL/min/1.73 m²，贫血患者为49.2±18.5；P = 0.021）。C反应蛋白无差异。与其他组相比，接受血管紧张素转换酶抑制剂（ACEI）和血管紧张素II受体阻滞剂（ARB）联合治疗的患者贫血患病率最高（42.9%，P = 0.027）。这些药物治疗的患者EPO水平显著较低（P = 0.041），转铁蛋白和铁蛋白无差异。接受雷帕霉素靶蛋白抑制剂（mTORi）治疗的贫血患者比例为31%，未接受这些免疫抑制剂治疗的患者为22.2%（P = 0.23）。尽管血红蛋白水平无差异，但接受mTORi治疗的患者EPO水平较高（P = 0.005），平均红细胞体积较低（P < 0.001）。关于慢性肾脏病的病因，多囊肾病患者贫血的频率较低（8.6%，其余为26.7%，P = 0.021）。通过多元线性回归得到的计算血红蛋白的公式为：血红蛋白 = 11829 - 0909 log（EPG水平） - 0455（如果是女性）+ 0.010 0.013转铁蛋白 + 0.013肌酐清除率（r = 0.424，P < 0.001）。
ACEI和/或ARB治疗似乎导致EPO合成缺陷，而mTORi治疗导致反应低下状态。
