Matos Cácia Mendes, Silva Luciana Ferreira, D'Ávila Melo Nelson Almeida, Kuwano André Yoichi, Kuwano Andreia Nunes, Azul Paula Serra, Barros Luisa Leite, Pisoni Ronald L, Lopes Antonio Alberto
Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, BA - Brazil and Institute of Nephrology and Dialysis, Salvador, BA - Brazil.
Int J Artif Organs. 2013 Oct 3;36(9):640-9. doi: 10.5301/ijao.5000204. Epub 2013 May 20.
BACKGROUND/OBJECTIVE: Findings from the international DOPPS indicated a rise in hemoglobin levels for patients on maintenance hemodialysis (MHD) for more than 180 days across many countries with more than 60% with hemoglobin ≥11 g/dl. However, the situation of anemia control for a large contingent of the hemodialysis population remains unknown. Studies in the United States indicate that hemoglobin level is lower for African Americans on MHD, but studies in other populations of African descent are lacking. We investigated the prevalence of, and associated factors for, hemoglobin <11 g/dl in MHD patients from the Brazilian city with the largest proportion of African descendants outside Africa.
Cross-sectional study of 1,263 MHD patients enrolled in the Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO) in Salvador, Brazil 2005-2009.
88.0% black or mixed race; age 49.0 ± 14.7 years; 96.6% receiving erythropoietin, median = 6,000 units/week. In patients on MHD for more than 180 days, 67.4% had hemoglobin <11 g/dl. Factors associated with hemoglobin<11 g/dl were MHD by catheter (odds ratio (OR) = 3.03, 95% confidence interval (CI) = 1.43-6.42), hospitalization in prior 3 months (OR = 2.14, 95% CI = 1.20-3.83), transferrin saturation <20% (OR = 1.49, 95% CI = 1.05-2.12) and higher malnutrition-inflammation score (OR = 1.58 per each log-transformed unit, 95% CI = 1.14-2.19).
The results suggest that iron deficiency, insufficient erythropoietin dose, catheter use, malnutrition-inflammation, and problems associated with hospitalization are explanations for the high prevalence of hemoglobin below the guideline target in MHD patients from a large African descent Brazilian population. These results have implications for understanding the lower hemoglobin concentration in MHD populations of African descent.
背景/目的：国际透析预后与实践模式研究（DOPPS）的结果表明，在许多国家，维持性血液透析（MHD）超过180天的患者血红蛋白水平有所上升，超过60%的患者血红蛋白≥11 g/dl。然而，大量血液透析人群的贫血控制情况仍不清楚。美国的研究表明，接受MHD的非裔美国人血红蛋白水平较低，但缺乏对其他非洲裔人群的研究。我们调查了非洲以外非洲后裔比例最高的巴西城市中MHD患者血红蛋白<11 g/dl的患病率及其相关因素。
对2005 - 2009年巴西萨尔瓦多纳入慢性血液透析患者预后前瞻性研究（PROHEMO）的1263例MHD患者进行横断面研究。
88.0%为黑人或混血人种；年龄49.0±14.7岁；96.6%接受促红细胞生成素治疗，中位数为6000单位/周。在MHD超过180天的患者中，67.4%的患者血红蛋白<11 g/dl。与血红蛋白<11 g/dl相关的因素包括使用导管进行MHD（比值比（OR）=3.03，95%置信区间（CI）=1.43 - 6.42）、前3个月内住院（OR =2.14，95% CI =1.20 - 3.83）、转铁蛋白饱和度<20%（OR =1.49，95% CI =1.05 - 2.12）以及较高的营养不良 - 炎症评分（每增加一个对数转换单位OR =1.58，95% CI =1.14 - 2.19）。
结果表明，缺铁、促红细胞生成素剂量不足、导管使用、营养不良 - 炎症以及与住院相关的问题，是非洲裔巴西人群中MHD患者血红蛋白低于指南目标患病率高的原因。这些结果对于理解非洲裔MHD人群中较低的血红蛋白浓度具有重要意义。
