腹膜透析贫血患者促红细胞生成素低反应性的相关因素

Factors Related to Erythropoietin Hyporesponsiveness in Peritoneal Dialysis Patients with Anemia.

作者信息

Makruasi Nisa, Changsirikulchai Siribha, Janma Jirayut, Rattanamongkolgul Suthee

出版信息

J Med Assoc Thai. 2016 Nov;99 Suppl 8:S48-S52.

PMID:29901907

Abstract

BACKGROUND

Anemia in peritoneal dialysis (PD) patients can be improved after treatment with erythropoietin (EPO). However, several factors previously reported can cause EPO hyporesponsiveness including nutritional deficiency, infection or inflammation, secondary hyperparathyroidism with bone marrow fibrosis, angiotensin converting enzyme inhibitor (ACEI) administration, and dialysis inadequacy. Correction of these factors may lower doses and costs of EPO for these patients.

OBJECTIVE

To calculate the prevalence of EPO hyporesponsiveness and the associated factors in PD patients with anemia.

MATERIAL AND METHOD

We reviewed medical records of 195 PD patients who received EPO treatment during January 2000 to June 2013.The doses of EPO were titrated maximally to 8,000 U/week to maintain a target Hematocrit (Hct) level between 33% and 36%. PD patients Hct less than 30% before and after EPO administration for 3 months were included in this study. There were 44 patients who were recruited by the criteria. They had no history of bleeding or red cell transfusions within 2 months. The EPO resistance index (ERI) was calculated as weekly EPO doses per Hct levels per kilograms body weight (kg). The EPO hyporesponsiveness was defined as the weekly EPO doses was >150 U/kg. The relationship between the ERI and continuous parameters was calculated by the student’s t-test. Chi-square and Fisher’s exact correlation were performed to analyze the relationship between ERI and categorical variables. The p-value <0.05 was considered statistically difference.

RESULTS

There were 13 (6.7%) patients having Hct less than 33% after the administration EPO >150 U/kg/week for 3 months. The statistically significant relationship between ERI and gender was detected. Female had higher rate of having EPO hyporesponsiveness (p = 0.02).

CONCLUSION

The prevalence of EPO hyporesponsiveness was 6.7%. Female gender was a factor related to EPO hyporesponsiveness in our study.

摘要

背景

腹膜透析（PD）患者的贫血在接受促红细胞生成素（EPO）治疗后可得到改善。然而，先前报道的几个因素可导致EPO反应低下，包括营养缺乏、感染或炎症、继发性甲状旁腺功能亢进伴骨髓纤维化、使用血管紧张素转换酶抑制剂（ACEI）以及透析不充分。纠正这些因素可能会降低这些患者的EPO剂量和费用。

目的

计算贫血的PD患者中EPO反应低下的患病率及相关因素。

材料与方法

我们回顾了2000年1月至2013年6月期间接受EPO治疗的195例PD患者的病历。EPO剂量最大滴定至8000 U/周，以维持血细胞比容（Hct）目标水平在33%至36%之间。本研究纳入了EPO给药3个月前后Hct低于30%的PD患者。有44例患者符合该标准入选。他们在2个月内无出血或红细胞输血史。EPO抵抗指数（ERI）计算为每千克体重（kg）的每周EPO剂量除以Hct水平。EPO反应低下定义为每周EPO剂量>150 U/kg。通过学生t检验计算ERI与连续参数之间的关系。采用卡方检验和Fisher精确相关性分析ERI与分类变量之间的关系。p值<0.05被认为具有统计学差异。