Ifudu O, Matthew J J, Mayers J D, Macey L J, Brezsnyak W, Reydel C, McClendon E, Surgrue T, Rao S, Friedman E A
Department of Medicine, State University of New York Health Science Center, Brooklyn 11203, USA.
Am J Kidney Dis. 1997 Jul;30(1):28-35. doi: 10.1016/s0272-6386(97)90561-8.
To determine the factors that govern their response to erythropoietin (EPO), we conducted a cross-sectional study of all patients in four outpatient hemodialysis facilities in Brooklyn, NY, who had end-stage renal disease (ESRD) and human immunodeficiency virus (HIV) infection and were receiving recombinant EPO. We also compared the hematocrit and EPO requirements of these patients to those of a control group of hemodialysis patients without HIV infection. We documented known duration of HIV infection, and total CD4 count was measured once. In both groups, hematocrit was measured weekly for 5 weeks and a mean value calculated for each subject. Transferrin saturation was measured twice and a mean value calculated for each subject. Intensity of hemodialysis was assessed by measuring both percent reduction of urea and serum albumin concentration twice; mean values were calculated for each subject. Twenty-nine (88%) of 33 study subjects had acquired immunodeficiency syndrome. Mean known duration of HIV infection was 49 +/- 32.5 months (median, 48 months), and mean total CD4 count was 143 +/- 152.4 cells/mm3 (median, 72 cells/mm3). Mean hematocrit in the study subjects was 27.4% +/- 4.7% compared with 27.6% +/- 3.7% in the controls (P = 0.69). Mean thrice-weekly EPO dose was higher in the study subjects (90 +/- 52 U/kg body weight) than in the controls (62 +/- 36 U/Kg body weight) (P = 0.001). Among the study subjects, hematocrit had direct univariate correlations with serum albumin concentration (r = 0.43; P = 0.02), transferrin saturation (r = 0.4; P = 0.03), and percent reduction of urea (r = 0.4; P = 0.02), but not with total CD4 count (r = -0.05; P = 0.8) or known duration of HIV infection (r = -0.11; P = 0.55). There was an inverse correlation between hematocrit and dose of EPO (r = -0.5; P = 0.003). Multiple regression analysis showed that transferrin saturation (P = 0.01) and percent reduction of urea (P = 0.003) had direct correlations with hematocrit after adjustment for other factors. There was an inverse relationship between hematocrit and dose of EPO (P = 0.0006). We conclude that in patients with ESRD and HIV infection receiving hemodialysis, the response to EPO (hematocrit) is modulated by the dose of EPO, quantity of hemodialysis, and transferrin saturation, but not by the severity of HIV disease. Hemodialysis patients infected with HIV receive a higher dose of EPO than those without HIV infection.
为了确定影响他们对促红细胞生成素（EPO）反应的因素，我们对纽约布鲁克林四个门诊血液透析机构中所有患有终末期肾病（ESRD）和人类免疫缺陷病毒（HIV）感染且正在接受重组EPO治疗的患者进行了一项横断面研究。我们还将这些患者的血细胞比容和EPO需求量与一组无HIV感染的血液透析患者对照组进行了比较。我们记录了已知的HIV感染持续时间，并测量了一次总CD4细胞计数。在两组中，每周测量血细胞比容5周，并为每个受试者计算平均值。测量转铁蛋白饱和度两次，并为每个受试者计算平均值。通过两次测量尿素降低百分比和血清白蛋白浓度来评估血液透析强度；为每个受试者计算平均值。33名研究对象中有29名（88%）患有获得性免疫缺陷综合征。已知HIV感染的平均持续时间为49±32.5个月（中位数为48个月），平均总CD4细胞计数为143±152.4个细胞/mm³（中位数为72个细胞/mm³）。研究对象的平均血细胞比容为27.4%±4.7%，而对照组为27.6%±3.7%（P = 0.69）。研究对象每周三次的平均EPO剂量（90±52 U/kg体重）高于对照组（62±36 U/Kg体重）（P = 0.001）。在研究对象中，血细胞比容与血清白蛋白浓度（r = 0.43；P = 0.02）、转铁蛋白饱和度（r = 0.4；P = 0.03）和尿素降低百分比（r = 0.4；P = 0.02）呈直接单变量相关性，但与总CD4细胞计数（r = -0.05；P = 0.8）或已知HIV感染持续时间（r = -0.11；P = 0.55）无关。血细胞比容与EPO剂量呈负相关（r = -0.5；P = 0.003）。多元回归分析表明，在调整其他因素后，转铁蛋白饱和度（P = 0.01）和尿素降低百分比（P = 0.003）与血细胞比容呈直接相关性。血细胞比容与EPO剂量呈负相关（P = 0.0006）。我们得出结论，在接受血液透析的ESRD和HIV感染患者中，对EPO的反应（血细胞比容）受EPO剂量、血液透析量和转铁蛋白饱和度的调节，但不受HIV疾病严重程度的影响。感染HIV的血液透析患者比未感染HIV的患者接受更高剂量的EPO。
