Madore F, Lowrie E G, Brugnara C, Lew N L, Lazarus J M, Bridges K, Owen W F
Centre de Recherche, Hôpital du Sacré-Coeur, Université de Montreal, Quebec, Canada.
J Am Soc Nephrol. 1997 Dec;8(12):1921-9. doi: 10.1681/ASN.V8121921.
Despite the prevalent use of recombinant human erythropoietin (rhEPO), anemia is a frequent finding in hemodialysis patients. The goal of this study was to evaluate the impact of anemia on patient survival and characterize the determinants of hematopoiesis that may be amenable to therapeutic manipulation to enhance rhEPO responsiveness and reduce death risk. Patient characteristics and laboratory data were collected for 21,899 patients receiving hemodialysis three times per week in dialysis centers throughout the United States in 1993. Hemoglobin concentrations (Hb) < or =80 g/L were associated with a twofold increase in the odds of death (odds ratio = 2.01; P = 0.001) when compared with Hb 100 to 110 g/L. No improvement in the odds of death was afforded for Hb >110 g/L. Using multiple linear regression, variables of rhEPO administration (rhEPO dose and percentage of treatments that rhEPO was administered), variables of iron status (serum iron, transferrin saturation, and ferritin), variables of nutritional status (serum albumin and creatinine concentration), and the dose of dialysis (urea reduction ratio) were found to be significantly associated with hemoglobin concentration (P < 0.001). Age, race, and gender were also found to be significantly associated with hemoglobin concentrations (P < 0.001). From this report, the following conclusions may be made. (1) Anemia may be predictive of an increased risk of mortality in some hemodialysis patients. (2) Hemoglobin concentrations > 110 g/L are not associated with further improvements in the odds of death. (3) Laboratory surrogates of iron stores, nutritional status, and the delivered dose of dialysis are predictive of hemoglobin concentration. Whether manipulation of the factors that improve anemia will also enhance the survival of patients on hemodialysis is unknown and should be evaluated by prospective, interventional studies.
尽管重组人促红细胞生成素（rhEPO）已被广泛应用，但贫血仍是血液透析患者中常见的现象。本研究的目的是评估贫血对患者生存的影响，并确定造血的决定因素，这些因素可能适合通过治疗手段进行调控，以增强rhEPO反应性并降低死亡风险。1993年，在美国各地的透析中心收集了21899例每周接受三次血液透析患者的特征和实验室数据。与血红蛋白（Hb）水平在100至110 g/L的患者相比，Hb浓度≤80 g/L的患者死亡几率增加了两倍（优势比=2.01；P=0.001）。Hb>110 g/L的患者死亡几率并未得到改善。通过多元线性回归分析发现，rhEPO给药变量（rhEPO剂量和rhEPO给药治疗的百分比）、铁状态变量（血清铁、转铁蛋白饱和度和铁蛋白）、营养状态变量（血清白蛋白和肌酐浓度）以及透析剂量（尿素清除率）与血红蛋白浓度显著相关（P<0.001）。年龄、种族和性别也与血红蛋白浓度显著相关（P<0.001）。根据本报告，可得出以下结论：（1）贫血可能预示着某些血液透析患者死亡风险增加。（2）血红蛋白浓度>110 g/L与死亡几率的进一步改善无关。（3）铁储备、营养状态和透析剂量的实验室替代指标可预测血红蛋白浓度。改善贫血的因素调控是否也能提高血液透析患者的生存率尚不清楚，应通过前瞻性干预研究进行评估。
