Department of Pediatric Nephrology, School of Medicine, Gazi University, Ankara, Turkey.
Department of Pediatric Nephrology, Dr. Behçet Uz Children's Hospital, Izmir, Turkey.
Pediatr Nephrol. 2018 Nov;33(11):2143-2150. doi: 10.1007/s00467-018-4013-4. Epub 2018 Aug 13.
During erythropoietin-stimulating agent (ESA) treatment, hemoglobin (Hb) levels usually fluctuate; this phenomenon is known as "Hb cycling (HC)." In this study, we aimed to evaluate the predictors of HC and its impact on left ventricular hypertrophy (LVH) as a patient-important outcome parameter in pediatric dialysis patients.
Records of patients followed up in nine pediatric nephrology centers between 2008 and 2013 were reviewed. More than 1 g/dL decrease or increase in Hb level was considered as HC. Patients were divided into two groups according to 12-month Hb trajectory as rare cycling (RC) (≤ 3) and frequent cycling (FC) (> 3 fluctuation) as well as three groups based on T-A-Hb levels: < 10, 10-11, and > 11 g/dL.
Two hundred forty-five dialysis (160 peritoneal dialysis (PD) and 85 hemodialysis (HD)) patients aged 12.3 ± 5.1 (range 0.5-21) years were enrolled in this study. Fifty-two percent of the patients had RC, 45% had FC, and only 3% had no cycling. There were no differences between HC groups with respect to age, dialysis modality, having anemia, hospitalization rate, residual urine volume, and mortality. Although left ventricular mass index (LVMI) tended to be higher in RC than FC group (65 ± 37 vs 52 ± 23 g/m, p = 0.056), prevalence of LVH was not different between the groups (p = 0.920). In regression analysis, FC was not a risk factor for LVH, but low T-A Hb level (< 10 g/dL) was a significant risk for LVH (OR = 0.414, 95% CI 0.177-0.966, p = 0.04). The target Hb levels were more often achieved in PD patients, and the number of deaths was significantly lower in non-anemic patients (Hb level > 11 g/dL).
Hb cycling is common among dialysis patients. Severity of anemia rather than its cycling has more significant impact on the prevalence of LVH and on inflammatory state.
在促红细胞生成素刺激剂（ESA）治疗期间，血红蛋白（Hb）水平通常会波动；这种现象被称为“Hb 循环（HC）”。本研究旨在评估 HC 的预测因素及其作为儿科透析患者重要的患者结局参数对左心室肥厚（LVH）的影响。
回顾了 2008 年至 2013 年间在九个儿科肾病中心接受治疗的患者的记录。Hb 水平下降或增加超过 1g/dL 被认为是 HC。根据 12 个月 Hb 轨迹，患者被分为两组：罕见循环（RC）（≤3）和频繁循环（FC）（>3 次波动），根据 T-A-Hb 水平也分为三组：<10、10-11 和>11g/dL。
本研究共纳入 245 名透析（160 名腹膜透析（PD）和 85 名血液透析（HD））患者，年龄为 12.3±5.1（0.5-21）岁。52%的患者有 RC，45%的患者有 FC，只有 3%的患者没有循环。HC 组在年龄、透析方式、贫血、住院率、残余尿量和死亡率方面无差异。尽管 RC 组的左心室质量指数（LVMI）高于 FC 组（65±37 vs 52±23g/m，p=0.056），但两组 LVH 的患病率无差异（p=0.920）。在回归分析中，FC 不是 LVH 的危险因素，但低 T-A Hb 水平（<10g/dL）是 LVH 的显著危险因素（OR=0.414，95%CI 0.177-0.966，p=0.04）。PD 患者的目标 Hb 水平更常达到，非贫血患者（Hb 水平>11g/dL）的死亡率明显降低。
Hb 循环在透析患者中很常见。贫血的严重程度而不是其循环对 LVH 的患病率和炎症状态有更显著的影响。
