老年糖尿病血液透析患者两种贫血治疗策略的效果相似。
Similar Outcomes for Two Anemia Treatment Strategies among Elderly Hemodialysis Patients with Diabetes.
作者信息
Thamer M, Zhang Y, Kaufman J, Cotter D, Hernán M A
机构信息
Medical Technology and Practice Patterns Institute, 5272 River Road, Suite 500, Bethesda, MD 20816, USA.
VA NY Harbor Healthcare System, 423 East 23rd St New York, NY 10010, USA.
出版信息
J Endocrinol Diabetes. 2014;1(2). doi: 10.15226/2374-6890/1/2/00111.
BACKGROUND/AIMS: To compare mortality and cardiovascular risk in elderly dialysis patients with diabetes under two clinical strategies of anemia correction: maintaining hematocrit (Hct) between 34.5 and < 39.0% (high Hct strategy), and between 30.0 and <34.5% (low Hct strategy) using intravenous alpha epoetin.
METHODS
Observational data were used to emulate a randomized trial in which diabetic patients who initiated hemodialysis in 2006-2008 were assigned to each anemia correction strategy. Inverse-probability weighting was used to adjust for measured time-dependent confounding.
RESULTS
Comparing high with low hematocrit strategy, the hazard ratio (95% confidence interval) was 1.07 (0.83, 1.38) for all-cause mortality and 1.00 (0.81, 1.24) for a composite mortality and cardiovascular endpoint.
CONCLUSIONS
Among a cohort of elderly hemodialysis patients with diabetes, no differences were found between the low and high hematocrit strategies. A lower target hematocrit - per current Food and Drug Administration (FDA) guidelines - appears to be as safe as higher targets among this population.
背景/目的：比较老年糖尿病透析患者在两种贫血纠正临床策略下的死亡率和心血管风险，这两种策略分别是：使用静脉注射α促红细胞生成素将血细胞比容（Hct）维持在34.5%至<39.0%之间（高血细胞比容策略），以及维持在30.0%至<34.5%之间（低血细胞比容策略）。
方法
利用观察性数据模拟一项随机试验，将2006 - 2008年开始进行血液透析的糖尿病患者分配至每种贫血纠正策略组。采用逆概率加权法对测量的时间依赖性混杂因素进行调整。
结果
高血细胞比容策略与低血细胞比容策略相比，全因死亡率的风险比（95%置信区间）为1.07（0.83，1.38），综合死亡率和心血管终点的风险比为1.00（0.81，1.24）。
结论
在一组老年糖尿病血液透析患者中，低血细胞比容策略和高血细胞比容策略之间未发现差异。按照美国食品药品监督管理局（FDA）目前的指南，较低的目标血细胞比容在该人群中似乎与较高目标一样安全。
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