Department of Ophthalmology, Taipei Medical University Hospital, Taipei 110, Taiwan.
Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 100, Taiwan.
Int J Mol Sci. 2022 Aug 25;23(17):9634. doi: 10.3390/ijms23179634.
This population-based retrospective cohort study investigated the effectiveness of erythropoietin (EPO) treatment in reducing the risk of age-related macular degeneration (AMD) in hemodialysis patients, using the National Health Insurance Research Data of Taiwan. From the database, we identified 147,318 end-stage renal disease (ESRD) patients on hemodialysis who had been diagnosed in 2000−2014 to establish the propensity-score-matched EPO user cohort and non-EPO user cohort with equal sample size of 15,992. By the end of 2016, the cumulative incidence of AMD in EPO users was about 3.29% lower than that in non-EPO users (Kaplan−Meier survival p < 0.0001). The risk of AMD was 43% lower in EPO users than in non-EPO users, with an adjusted hazard ratio (aHR) of 0.57 (95% confidence interval (CI) = 0.51−0.64) estimated in the multivariate Cox model. A significant negative dose−response relationship was identified between the EPO dosage and the risk of AMD (p < 0.0001). Another beneficial effect of EPO treatment was a reduced risk of both exudative AMD (aHR = 0.48, 95% CI = 0.40−0.61) and non-exudative AMD (aHR = 0.61, 95% CI = 0.53−0.69), also in similar dose−response relationships (p < 0.0001). Our findings suggest that EPO treatment for hemodialysis patients could reduce AMD risk in a dose−response relationship.
本基于人群的回顾性队列研究利用台湾全民健康保险研究数据库，调查了促红细胞生成素（EPO）治疗对减少血液透析患者年龄相关性黄斑变性（AMD）风险的效果。从数据库中，我们确定了 2000-2014 年间被诊断为终末期肾病（ESRD）的 147318 名血液透析患者，建立了 EPO 使用者队列和非 EPO 使用者队列，每个队列的样本量相等，为 15992 人。到 2016 年底，EPO 使用者的 AMD 累积发生率比非 EPO 使用者低约 3.29%（Kaplan-Meier 生存 p < 0.0001）。在多变量 Cox 模型中，EPO 使用者的 AMD 风险比非 EPO 使用者低 43%，调整后的风险比（aHR）为 0.57（95%置信区间（CI）=0.51-0.64）。EPO 剂量与 AMD 风险之间存在显著的负剂量-反应关系（p < 0.0001）。EPO 治疗的另一个有益效果是降低了渗出性 AMD（aHR = 0.48，95%CI = 0.40-0.61）和非渗出性 AMD（aHR = 0.61，95%CI = 0.53-0.69）的风险，也存在类似的剂量-反应关系（p < 0.0001）。我们的研究结果表明，EPO 治疗血液透析患者可能会降低 AMD 风险，且呈剂量-反应关系。
