Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
Mediators Inflamm. 2020 Nov 26;2020:1027230. doi: 10.1155/2020/1027230. eCollection 2020.
Renal anemia is a common complication of hemodialysis patients. Erythropoietin (EPO) hyporesponsiveness has been recognized as an important factor to poor efficacy of recombinant human erythropoietin in the treatment of renal anemia. More importantly, increased erythropoiesis resistance index (ERI) may be associated with inflammation and increased mortality.
The objective of this research was to investigate correlated factors of EPO responsiveness and to clarify the relationships between EPO hyporesponsiveness and cardiovascular mortality and all-cause mortality among maintenance hemodialysis patients.
This prospective cohort study enrolled 276 maintenance hemodialysis patients for a 55-month follow-up to investigate the factors related to ERI and its relationship to all-cause mortality and cardiovascular mortality.
ERI was positively correlated with predialysis serum high-sensitivity C-reactive protein ( = 0.234, < 0.001), alkaline phosphatase ( = 0.134, = 0.028), and ferritin ( = 0.155, = 0.010) and negatively correlated with albumin ( = -0.206, < 0.001) and creatinine ( = -0.232, < 0.001). As multiple linear regression showed, predialysis serum albumin, high-sensitivity C-reactive protein, ferritin, and creatinine were independent correlated factors of ERI ( < 0.05). Kaplan-Meier curves showed that the cumulative incidences of both cardiovascular mortality and all-cause mortality were significantly higher in patients with ERI > 11.04 IU/kg/w/g/dL (both < 0.01). The high ERI group was significantly associated with higher risk for all-cause mortality (OR 1.781, 95% CI 1.091 to 2.910, = 0.021) and cardiovascular mortality (OR 1.972, 95% CI 1.139 to 3.417, = 0.015) after adjusting for confounders.
Predialysis serum albumin, high-sensitivity C-reactive protein, ferritin, and creatinine were independent correlated factors of EPO responsiveness among maintenance hemodialysis patients. Patients with higher ERI values had a higher all-cause mortality rate and cardiovascular mortality rate.
肾性贫血是血液透析患者常见的并发症。促红细胞生成素（EPO）反应低下已被认为是重组人促红细胞生成素治疗肾性贫血疗效不佳的重要因素。更重要的是，红细胞生成抵抗指数（ERI）的增加可能与炎症和死亡率的增加有关。
本研究旨在探讨 EPO 反应性的相关因素，并阐明维持性血液透析患者中 EPO 反应低下与心血管死亡率和全因死亡率之间的关系。
本前瞻性队列研究纳入了 276 名维持性血液透析患者进行了 55 个月的随访，以研究与 ERI 相关的因素及其与全因死亡率和心血管死亡率的关系。
ERI 与透析前血清高敏 C 反应蛋白（ = 0.234，<0.001）、碱性磷酸酶（ = 0.134， = 0.028）和铁蛋白（ = 0.155， = 0.010）呈正相关，与白蛋白（ = -0.206，<0.001）和肌酐（ = -0.232，<0.001）呈负相关。多元线性回归显示，透析前血清白蛋白、高敏 C 反应蛋白、铁蛋白和肌酐是 ERI 的独立相关因素（<0.05）。Kaplan-Meier 曲线显示，ERI > 11.04 IU/kg/w/g/dL 的患者心血管死亡率和全因死亡率的累积发生率均显著升高（均<0.01）。高 ERI 组与全因死亡率（OR 1.781，95%CI 1.091 至 2.910， = 0.021）和心血管死亡率（OR 1.972，95%CI 1.139 至 3.417， = 0.015）显著相关，校正混杂因素后。
维持性血液透析患者透析前血清白蛋白、高敏 C 反应蛋白、铁蛋白和肌酐是 EPO 反应性的独立相关因素。ERI 值较高的患者全因死亡率和心血管死亡率较高。
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