在线血液透析滤过和超纯低通量血液透析治疗患者对促红细胞生成素刺激剂的抵抗：一项随机对照试验（CONTRAST）的结果

Resistance to erythropoiesis stimulating agents in patients treated with online hemodiafiltration and ultrapure low-flux hemodialysis: results from a randomized controlled trial (CONTRAST).

作者信息

van der Weerd Neelke C, Den Hoedt Claire H, Blankestijn Peter J, Bots Michiel L, van den Dorpel Marinus A, Lévesque Renée, Mazairac Albert H A, Nubé Menso J, Penne E Lars, ter Wee Pieter M, Grooteman Muriel P C

机构信息

Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands; Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands.

Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands.

出版信息

PLoS One. 2014 Apr 17;9(4):e94434. doi: 10.1371/journal.pone.0094434. eCollection 2014.

DOI:10.1371/journal.pone.0094434

PMID:24743493

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3990567/

Abstract

UNLABELLED

Resistance to erythropoiesis stimulating agents (ESA) is common in patients undergoing chronic hemodialysis (HD) treatment. ESA responsiveness might be improved by enhanced clearance of uremic toxins of middle molecular weight, as can be obtained by hemodiafiltration (HDF). In this analysis of the randomized controlled CONvective TRAnsport STudy (CONTRAST; NCT00205556), the effect of online HDF on ESA resistance and iron parameters was studied. This was a pre-specified secondary endpoint of the main trial. A 12 months' analysis of 714 patients randomized to either treatment with online post-dilution HDF or continuation of low-flux HD was performed. Both groups were treated with ultrapure dialysis fluids. ESA resistance, measured every three months, was expressed as the ESA index (weight adjusted weekly ESA dose in daily defined doses [DDD]/hematocrit). The mean ESA index during 12 months was not different between patients treated with HDF or HD (mean difference HDF versus HD over time 0.029 DDD/kg/Hct/week [-0.024 to 0.081]; P = 0.29). Mean transferrin saturation ratio and ferritin levels during the study tended to be lower in patients treated with HDF (-2.52% [-4.72 to -0.31]; P = 0.02 and -49 ng/mL [-103 to 4]; P = 0.06 respectively), although there was a trend for those patients to receive slightly more iron supplementation (7.1 mg/week [-0.4 to 14.5]; P = 0.06). In conclusion, compared to low-flux HD with ultrapure dialysis fluid, treatment with online HDF did not result in a decrease in ESA resistance.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00205556.

摘要

未标注

接受慢性血液透析（HD）治疗的患者中，对促红细胞生成素刺激剂（ESA）产生耐药性很常见。通过增强对中分子量尿毒症毒素的清除，可能会改善ESA反应性，血液透析滤过（HDF）即可实现这一点。在这项对随机对照的对流转运研究（CONTRAST；NCT00205556）的分析中，研究了在线HDF对ESA耐药性和铁参数的影响。这是主要试验预先设定的次要终点。对714例随机接受在线后稀释HDF治疗或继续进行低通量HD治疗的患者进行了为期12个月的分析。两组均使用超纯透析液治疗。每三个月测量一次的ESA耐药性以ESA指数表示（每周按体重调整的ESA剂量以每日规定剂量[DDD]/血细胞比容）。接受HDF或HD治疗的患者在12个月期间的平均ESA指数没有差异（HDF与HD随时间的平均差异为0.029 DDD/kg/Hct/周[-0.024至0.081]；P = 0.29）。尽管接受HDF治疗的患者有接受略多铁补充剂的趋势（7.1 mg/周[-0.4至14.5]；P = 0.06），但在研究期间，这些患者的平均转铁蛋白饱和度和铁蛋白水平往往较低（分别为-2.52%[-4.72至-0.31]；P = 0.02和-49 ng/mL[-103至4]；P = 0.06）。总之，与使用超纯透析液的低通量HD相比，在线HDF治疗并未导致ESA耐药性降低。