Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.
Department of Statistics, Kyungpook National University, Daegu, South Korea.
Sci Rep. 2020 Sep 29;10(1):16062. doi: 10.1038/s41598-020-73124-x.
The response to erythropoiesis stimulating agents (ESAs) is affected by inflammation linked to middle molecules in hemodialysis (HD) patients. We evaluated the effect of a medium cut-off (MCO) dialyzer on ESA resistance in maintenance HD patients. Forty-nine patients who underwent high-flux HD were randomly allocated to the MCO or high-flux group. The primary outcome was the changes of erythropoietin resistance index (ERI; U/kg/wk/g/dL) between baseline and 12 weeks. The MCO group showed significant decrease in the ESA dose, weight-adjusted ESA dose, and ERI compared to the high-flux group at 12 weeks (p < 0.05). The generalized estimating equation models revealed significant interactions between groups and time for the ESA dose, weight-adjusted ESA dose, and ERI (p < 0.05). Serum iron and transferrin saturation were higher in the MCO group at 12 weeks (p < 0.05). The MCO group showed a greater reduction in TNF-α and lower serum TNF-α level at 12 weeks compared to the high-flux group (p < 0.05), whereas no differences were found in the reduction ratio of hepcidin and serum levels of erythropoietin, erythroferrone, soluble transferrin receptor and hepcidin between groups. HD with MCO dialyzer improves ESA resistance over time compared to high-flux HD in maintenance HD patients. The MCO dialyzer provides superior removal of the inflammatory cytokine and thus improves iron metabolism in a hepcidin-independent manner.
促红细胞生成素刺激剂（ESA）的反应受与血液透析（HD）患者中中分子相关的炎症影响。我们评估了中分子截留（MCO）透析器对维持性 HD 患者 ESA 抵抗的影响。49 名接受高通量 HD 的患者被随机分配到 MCO 或高通量组。主要结局是基线至 12 周时红细胞生成素抵抗指数（ERI；U/kg/wk/g/dL）的变化。与高通量组相比，MCO 组在 12 周时 ESA 剂量、体重校正 ESA 剂量和 ERI 显著降低（p<0.05）。广义估计方程模型显示，ESA 剂量、体重校正 ESA 剂量和 ERI 组间和时间存在显著交互作用（p<0.05）。12 周时 MCO 组血清铁和转铁蛋白饱和度较高（p<0.05）。与高通量组相比，MCO 组在 12 周时 TNF-α 降低更多，血清 TNF-α 水平更低（p<0.05），而各组之间铁调素的降低率和血清红细胞生成素、红细胞生成素、可溶性转铁蛋白受体和铁调素水平无差异。与高通量 HD 相比，MCO 透析器可改善维持性 HD 患者 ESA 抵抗，随时间推移逐渐改善。MCO 透析器可更好地清除炎症细胞因子，从而在不依赖铁调素的情况下改善铁代谢。
