Kang Seok-Hui, Kim A-Young
Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea.
J Clin Med. 2025 Jul 9;14(14):4863. doi: 10.3390/jcm14144863.
Our study aimed to evaluate the differences in hemoglobin variability among patients undergoing hemodialysis (HD) treated with three types of erythropoiesis-stimulating agents (ESAs) and the association between hemoglobin variability and clinical outcomes. In this study, data from the 6th and 7th HD quality assessments were used, comprising 48,726 patients in South Korea. ESAs are categorized into short-acting (epoetin alfa/beta/delta, requiring more frequent administration), intermediate-acting (darbepoetin alfa), and long-acting agents (methoxy polyethylene glycol-epoetin beta, requiring extended dosing intervals), each with distinct pharmacokinetic properties and dosing schedules. Based on use of ESA types, participants were divided into the following groups: Short, Intermediate, and Long. Hemoglobin levels were measured monthly over a 6-month assessment period. Hemoglobin variability was defined as the residual standard deviation derived from a within-subject linear regression model with six hemoglobin values for each patient. The Short, Intermediate, and Long groups comprised 36,420, 10,514, and 1792 patients, respectively. The hemoglobin variability (mean [95% confidence interval]) was 0.60 (0.60-0.60), 0.68 (0.67-0.68), and 0.64 (0.62-0.65) g/dL in the Short, Intermediate, and Long groups, respectively. Multivariate and subgroup analyses revealed that the hemoglobin variability was lower in the Short group than in the other two groups. Cox regression did not show a significant association between an increase in hemoglobin variability and all-cause mortality or cardiovascular events in univariate and multivariate analyses. Our cohort study found that the use of short-acting ESAs showed the lowest hemoglobin variability, whereas the use of intermediate-acting ESAs showed the highest variability. In the context of South Korea's healthcare system, where frequent hemoglobin monitoring and strict ranges are emphasized, short-acting ESAs combined with regular laboratory follow-up appeared to support more stable hemoglobin levels.
我们的研究旨在评估接受三种促红细胞生成素（ESA）治疗的血液透析（HD）患者血红蛋白变异性的差异，以及血红蛋白变异性与临床结局之间的关联。在本研究中，使用了来自韩国第6次和第7次HD质量评估的数据，共纳入48,726例患者。ESA分为短效（阿法/贝塔/德尔塔促红细胞生成素，需要更频繁给药）、中效（达贝泊汀α）和长效制剂（聚乙二醇化甲氧基促红细胞生成素β，给药间隔时间延长），每种制剂具有不同的药代动力学特性和给药方案。根据ESA类型的使用情况，参与者被分为以下几组：短效组、中效组和长效组。在6个月的评估期内每月测量血红蛋白水平。血红蛋白变异性定义为每个患者具有6个血红蛋白值的个体内线性回归模型得出的残差标准差。短效组、中效组和长效组分别包括36,420例、10,514例和1792例患者。短效组、中效组和长效组的血红蛋白变异性（均值[95%置信区间]）分别为0.60（0.60 - 0.60）、0.68（0.67 - 0.68）和0.64（0.62 - 0.65）g/dL。多变量和亚组分析显示，短效组的血红蛋白变异性低于其他两组。在单变量和多变量分析中，Cox回归未显示血红蛋白变异性增加与全因死亡率或心血管事件之间存在显著关联。我们的队列研究发现，使用短效ESA时血红蛋白变异性最低，而使用中效ESA时变异性最高。在强调频繁血红蛋白监测和严格范围的韩国医疗保健系统背景下，短效ESA结合定期实验室随访似乎有助于维持更稳定的血红蛋白水平。
