日本新发生血液透析患者透析前和透析后死亡的促红细胞生成素抵抗。
Resistance to Erythropoiesis-Stimulating Agents in Pre-Dialysis and Post-Dialysis Mortality in Japanese Incident Hemodialysis Patients.
机构信息
Division of Dialysis, Nissan Tamagawa Hospital, Tokyo, Japan.
Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan,
出版信息
Blood Purif. 2019;47 Suppl 2(Suppl 1):31-37. doi: 10.1159/000496634. Epub 2019 Apr 3.
BACKGROUND/AIMS: There is lack of definitive evidence about the association between erythropoiesis-stimulating agent (ESA) responsiveness in the pre-dialysis phase and mortality. Therefore, we conducted a hospital-based, retrospective, cohort study to assess the predictive value of ESA response for prognosis in incident hemodialysis patients.
METHODS
A total of 108 patients without preexisting cardiovascular disease who had been started on maintenance hemodialysis were studied. ESA responsiveness just before starting dialysis was estimated using an erythropoietin resistance index (ERI). The endpoint was defined as all-cause death.
RESULTS
During a mean follow-up period of 3.1 ± 1.6 years, 18 (17%) patients died. Overall, the multivariate Cox regression analysis revealed that the log-transformed ERI remained an independent predictor of all-cause death after adjustment using a propensity score (hazard ratio 2.25, 95% CI 1.25-4.06).
CONCLUSIONS
Among incident hemodialysis patients, hyporesponsiveness to ESA may be associated with mortality.
背景/目的：关于透析前阶段促红细胞生成刺激剂（ESA）反应与死亡率之间的关联，目前尚无明确证据。因此，我们进行了一项基于医院的回顾性队列研究，以评估 ESA 反应对新进入血液透析患者预后的预测价值。
方法
共纳入了 108 名无既往心血管疾病且已开始维持性血液透析的患者。在开始透析之前，使用促红细胞生成素抵抗指数（ERI）来评估 ESA 的反应性。终点定义为全因死亡。
结果
在平均 3.1±1.6 年的随访期间，18 名（17%）患者死亡。总体而言，多变量 Cox 回归分析显示，在使用倾向评分进行调整后，对数转换的 ERI 仍然是全因死亡的独立预测因子（危险比 2.25，95%CI 1.25-4.06）。
结论
在新进入血液透析的患者中，ESA 低反应性可能与死亡率相关。
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