Liu Wen-Sheng, Lin Chien-Hung, Tan Ann Charis, Lai Yen-Ting, Liu Tsung-Yun, Chan Hsiang-Lin, Li Szu-Yuan, Chen Chun-Fan, Chen Yung-Tai, Chen Tz-Heng, Chen Fan-Yu, Ho Yang, Tsou Han-Hsing, Lin Chih-Ching
Division of Nephrology, Department of Medicine, Taipei City Hospital, Zhongxing Branch, Taipei 103, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan.
Healthcare (Basel). 2023 Feb 3;11(3):442. doi: 10.3390/healthcare11030442.
Erythropoiesis-stimulating agents (ESA) are used to treat anemia in hemodialysis (HD) patients. We investigated the role of inflammation and accumulation of environmental toxins (perfluorinated chemicals (PFCs), such as perfluorooctanoic acid and perfluorooctane sulfonate) in the erythropoietic response of HD patients who receive a fixed monthly continuous erythropoietin receptor activator (CERA) dosage. Forty-five patients underwent three successive phases of ESA treatment for two months each (phase one: 100 µg CERA once monthly; phase two: 50 µg CERA twice monthly; phase three: 100 µg CERA once monthly). Patient data were collected to determine the association of various factors with erythropoietic response (change in hematocrit). Liquid chromatography-tandem mass spectrometry was used to analyze perfluorinated chemicals. Twenty-eight patients exhibited a poor erythropoietic response that was significantly associated with: age > 80 years, initial hematocrit > 36%, glucose > 200 mg/dL, alanine aminotransferase > 21 U/L, c-reactive protein > 1 mg/dL, interleukin-6 > 10 ng/mL, lactate dehydrogenase ≤ 190 U/L, and chloride ≤ 93 mEq/L. There was also a borderline significant association between inflammation and PFCs, although PFCs failed to show any impact on ESA response. Age, glucose, chloride, liver function, and inflammation may be associated with cost-effective fixed CERA dosage administered at an increased frequency.
促红细胞生成素（ESA）用于治疗血液透析（HD）患者的贫血。我们研究了炎症和环境毒素（全氟化合物（PFCs），如全氟辛酸和全氟辛烷磺酸）的蓄积在接受固定每月连续促红细胞生成素受体激活剂（CERA）剂量的HD患者促红细胞生成反应中的作用。45例患者接受了三个连续阶段的ESA治疗，每个阶段持续两个月（第一阶段：每月1次100μg CERA；第二阶段：每月2次50μg CERA；第三阶段：每月1次100μg CERA）。收集患者数据以确定各种因素与促红细胞生成反应（血细胞比容变化）之间的关联。采用液相色谱-串联质谱法分析全氟化合物。28例患者促红细胞生成反应较差，这与以下因素显著相关：年龄>80岁、初始血细胞比容>36%、血糖>200mg/dL、丙氨酸转氨酶>21U/L、C反应蛋白>1mg/dL、白细胞介素-6>10ng/mL、乳酸脱氢酶≤190U/L和氯化物≤93mEq/L。炎症与PFCs之间也存在临界显著关联，尽管PFCs对ESA反应未显示任何影响。年龄、血糖、氯化物、肝功能和炎症可能与以增加频率给予的具有成本效益的固定CERA剂量相关。
