UNC Kidney Center and.
J Am Soc Nephrol. 2014 Apr;25(4):819-26. doi: 10.1681/ASN.2013060575. Epub 2014 Jan 23.
African Americans require higher doses of erythropoiesis-stimulating agents (ESAs) during dialysis to manage anemia, but the influence of sickle cell trait and other hemoglobinopathy traits on anemia in dialysis patients has not been adequately evaluated. We performed a cross-sectional study of a large cohort of adult African-American hemodialysis patients in the United States to determine the prevalence of hemoglobinopathy traits and quantify their influence on ESA dosing. Laboratory and clinical data were obtained over 6 months in 2011. Among 5319 African-American patients, 542 (10.2%) patients had sickle cell trait, and 129 (2.4%) patients had hemoglobin C trait; no other hemoglobinopathy traits were present. Sickle cell trait was more common in this cohort than the general African-American population (10.2% versus 6.5%-8.7%, respectively, P<0.05). Among 5002 patients (10.3% sickle cell trait and 2.4% hemoglobin C trait) receiving ESAs, demographic and clinical variables were similar across groups, with achieved hemoglobin levels being nearly identical. Patients with hemoglobinopathy traits received higher median doses of ESA than patients with normal hemoglobin (4737.4 versus 4364.1 units/treatment, respectively, P=0.02). In multivariable analyses, hemoglobinopathy traits associated with 13.2% more ESA per treatment (P=0.001). Within subgroups, sickle cell trait patients received 13.2% (P=0.003) higher dose and hemoglobin C trait patients exhibited a similar difference (12.9%, P=0.12). Sensitivity analyses using weight-based dosing definitions and separate logistic regression models showed comparable associations. Our findings suggest that the presence of sickle cell trait and hemoglobin C trait may explain, at least in part, prior observations of greater ESA doses administered to African-American dialysis patients relative to Caucasian patients.
非裔美国人在透析期间需要更高剂量的促红细胞生成素刺激剂 (ESAs) 来治疗贫血，但镰状细胞特征和其他血红蛋白病特征对透析患者贫血的影响尚未得到充分评估。我们对美国一个大型非裔美国成年血液透析患者队列进行了横断面研究，以确定血红蛋白病特征的患病率，并量化它们对 ESA 剂量的影响。实验室和临床数据是在 2011 年的 6 个月内获得的。在 5319 名非裔美国患者中，542 名（10.2%）患者有镰状细胞特征，129 名（2.4%）患者有血红蛋白 C 特征；没有其他血红蛋白病特征。与一般非裔美国人人群相比，该队列中镰状细胞特征更为常见（分别为 10.2%和 6.5%-8.7%，P<0.05）。在接受 ESA 治疗的 5002 名患者中（10.3%镰状细胞特征和 2.4%血红蛋白 C 特征），各组之间的人口统计学和临床变量相似，达到的血红蛋白水平几乎相同。血红蛋白病特征患者接受的 ESA 中位剂量高于血红蛋白正常患者（分别为 4737.4 和 4364.1 单位/治疗，P=0.02）。在多变量分析中，血红蛋白病特征与每治疗增加 13.2%的 ESA 相关（P=0.001）。在亚组中，镰状细胞特征患者接受的剂量高出 13.2%（P=0.003），血红蛋白 C 特征患者也表现出类似的差异（12.9%，P=0.12）。使用基于体重的剂量定义和单独的逻辑回归模型进行的敏感性分析显示出类似的关联。我们的研究结果表明，镰状细胞特征和血红蛋白 C 特征的存在至少可以部分解释先前观察到的给予非裔美国透析患者的 ESA 剂量高于白种人患者的情况。
