通过在小透析袋中给药提高腹膜透析儿童腹腔内促红细胞生成素的生物利用度。

Increase of the bioavailability of intraperitoneal erythropoietin in children on peritoneal dialysis by administration in small dialysis bags.

作者信息

Reddingius R E, de Boer A W, Schröder C H, Willems J L, Monnens L A

机构信息

Department of Pediatrics, St. Radboud University Hospital, Nijmegen, The Netherlands.

出版信息

Perit Dial Int. 1997 Sep-Oct;17(5):467-70.

PMID:9358528

Abstract

OBJECTIVE

To establish the effectivity of administration of erythropoietin intraperitoneally in a small amount of fluid in children with renal anemia on continuous ambulatory peritoneal dialysis (CAPD).

DESIGN

Prospective study in which children with renal anemia on CAPD were treated with erythropoietin intraperitoneally, administered in a specially designed bag containing 50 mL NaCl 0.9%.

SETTING

University hospital.

PATIENTS

The patient population consisted of 9 children treated with CAPD and 1 treated with nightly intermittent peritoneal dialysis. The median age was 7.8 years (range 4.1-15.2). Four of these children had not been treated with erythropoietin before (group A), and 6 had been treated with erythropoietin administered intraperitoneally in 250 mL of dialysis fluid (group B).

INTERVENTIONS

Patients in group A started on a dose of approximately 300 units/kg per week (group A). Patients in group B received their previous dose. Dosage was adjusted to achieve a target hemoglobin level of 6.5-7.0 mmol/L (104-112 g/L). Serum ferritin levels and transferrin saturation were monitored and iron supplementation was prescribed in the case of iron deficiency.

MAIN OUTCOME MEASURES

Weekly erythropoietin dose in relation to hemoglobin level.

RESULTS

In group A, median hemoglobin level rose from 5.3 mmol/L (85 g/L) to 6.6 mmol/L (106 g/L) after 6 months of therapy, whereas the median erythropoietin dose decreased from 266 to 234 U/kg/week. In group B, hemoglobin levels remained stable and median erythropoietin dose decreased from 262 to 194 U/kg/week. One patient in this group, for unknown reasons, never responded to erythropoietin treatment. He was excluded from further analysis. In the remaining 5 patients the median cumulative erythropoietin dose was 3250 U/kg in the 3-month period prior to the start of the study and 2713 in the 3-month period starting 6 months after the beginning of the study. This difference of 17% was statistically significant using a Wilcoxon test (p < 0.05).

CONCLUSION

Intraperitoneal administration of erythropoietin in a small amount of dialysis fluid leads to a decrease in the required dose.

摘要

目的

确定小剂量腹腔内注射促红细胞生成素对持续非卧床腹膜透析（CAPD）的肾性贫血患儿的有效性。

设计

前瞻性研究，对接受CAPD的肾性贫血患儿采用腹腔内注射促红细胞生成素进行治疗，促红细胞生成素置于一个特别设计的装有50 mL 0.9%氯化钠的袋子中给药。

地点

大学医院。

患者

患者群体包括9名接受CAPD治疗的儿童和1名接受夜间间歇性腹膜透析治疗的儿童。中位年龄为7.8岁（范围4.1 - 15.2岁）。这些儿童中有4名此前未接受过促红细胞生成素治疗（A组），6名曾接受过在250 mL透析液中腹腔内注射促红细胞生成素的治疗（B组）。

干预措施

A组患者开始时每周剂量约为300单位/千克（A组）。B组患者接受其先前的剂量。调整剂量以达到目标血红蛋白水平6.5 - 7.0 mmol/L（104 - 112 g/L）。监测血清铁蛋白水平和转铁蛋白饱和度，缺铁时给予铁补充剂。

主要观察指标

每周促红细胞生成素剂量与血红蛋白水平的关系。

结果

在A组，治疗6个月后，血红蛋白中位水平从5.3 mmol/L（85 g/L）升至6.6 mmol/L（106 g/L），而促红细胞生成素中位剂量从266降至234 U/千克/周。在B组，血红蛋白水平保持稳定，促红细胞生成素中位剂量从262降至194 U/千克/周。该组中有1名患者，原因不明，对促红细胞生成素治疗从未有反应。他被排除在进一步分析之外。在其余5名患者中，研究开始前3个月促红细胞生成素累积中位剂量为32,50 U/千克，研究开始6个月后3个月期间为2713 U/千克。使用Wilcoxon检验，这种17%的差异具有统计学意义（p < 0.05）。