评价血液透析患者红细胞肌酸含量以评估重组人红细胞生成素反应性。

Evaluation of recombinant human erythropoietin responsiveness by measuring erythrocyte creatine content in haemodialysis patients.

机构信息

Department of Nephrology and Cardiology, Takarazuka Hospital, 2-1-2 Nogami, Takarazuka, Hyogo, 665-0022, Japan.

The Second Department of Internal Medicine, Kansai Medical University, Osaka, Japan.

出版信息

BMC Nephrol. 2021 Dec 12;22(1):413. doi: 10.1186/s12882-021-02623-4.

DOI:10.1186/s12882-021-02623-4

PMID:34895154

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8666014/

Abstract

BACKGROUND

One of the main causes of anaemia in patients with end-stage renal disease is relative deficiency in erythropoietin production. Eythropoiesis stimulating agent (ESA), a potent haematopoietic growth factor, is used to treat anaemia in haemodialysis patients. The effect of ESA is usually assessed by haematological indices such as red blood cell count, haemoglobin concentration and haematocrit, but erythrocyte indices do not provide information of the rapid change in erythropoietic activity. As erythrocyte creatine directly assess erythropoiesis, the aim of this study was to evaluate the effect of ESA in haemodialysis patients by measuring the erythrocyte creatine content.

METHODS

ESA dose was fixed 3 months prior to the enrollment and was maintained throughout the entire study period. Erythrocyte creatine was measured with haematologic indices in 83 haemodialysis patients. Haemoglobin was also measured 3 months after.

RESULTS

ESA dose (152.4 ± 62.9 vs. 82.2 ± 45.5 units/kg/week, P = 0.0001) and erythrocyte creatine (2.07 ± 0.73 vs. 1.60 ± 0.41 μmol/gHb, p = 0.0003) were significantly higher in 27 patients with haemoglobin <10 g/dL compared to 56 patients with haemoglobin ≥10 g/dL. There was a fair correlation between ESA dose and the concentration of creatine in the erythrocytes (r = 0.55, P < 0.0001). Increase in haemoglobin (>0.1 g/dL) was observed in 37 patients, whereas haemoglobin did not increase in 46 patients. Erythrocyte creatine levels were significantly higher in those patients with an increase in haemoglobin compared to those without (2.04 ± 0.64 vs. 1.52 ± 0.39 μmol/gHb, p < 0.0001). When 8 variables (ESA dose, erythropoietin resistance index, C-reactive protein, intact parathyroid hormone, iron supplementation, presence of anaemia, erythrocyte creatine and reticulocyte) were used in the multivariate logistic analysis, erythrocyte creatine levels emerged as the most important variable associated with increase in haemoglobin (Chi-square = 6.19, P = 0.01).

CONCLUSION

Erythrocyte creatine, a useful marker of erythropoietic capacity, is a reliable marker to estimate ameliorative effectiveness of ESA in haemodialysis patients.

摘要

背景

终末期肾病患者贫血的主要原因之一是促红细胞生成素产生相对不足。促红细胞生成素刺激剂（ESA）是一种有效的造血生长因子，用于治疗血液透析患者的贫血。ESA 的效果通常通过红细胞计数、血红蛋白浓度和血细胞比容等血液学指标来评估，但红细胞指标不能提供红细胞生成活性快速变化的信息。由于红细胞肌酸酐直接评估红细胞生成，因此本研究旨在通过测量红细胞肌酸酐含量来评估 ESA 对血液透析患者的作用。

方法

ESA 剂量在入组前 3 个月固定，并在整个研究期间保持不变。83 名血液透析患者在血液学指标的基础上测量红细胞肌酸酐。3 个月后也测量血红蛋白。

结果

血红蛋白<10g/dL 的 27 名患者与血红蛋白≥10g/dL 的 56 名患者相比，ESA 剂量（152.4±62.9 vs. 82.2±45.5 单位/kg/周，P=0.0001）和红细胞肌酸酐（2.07±0.73 vs. 1.60±0.41μmol/gHb，p=0.0003）均显著升高。ESA 剂量与红细胞肌酸酐浓度之间存在良好的相关性（r=0.55，P<0.0001）。37 名患者的血红蛋白增加（>0.1g/dL），而 46 名患者的血红蛋白没有增加。与血红蛋白未增加的患者相比，血红蛋白增加的患者的红细胞肌酸酐水平显著升高（2.04±0.64 vs. 1.52±0.39μmol/gHb，p<0.0001）。当将 8 个变量（ESA 剂量、红细胞生成素抵抗指数、C 反应蛋白、完整甲状旁腺激素、铁补充剂、贫血存在、红细胞肌酸酐和网织红细胞）用于多变量逻辑分析时，红细胞肌酸酐水平成为与血红蛋白增加最相关的最重要变量（卡方=6.19，P=0.01）。