Martino M A, Vogel K M, O'Brien S P, Kerstein M D
Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, USA.
J Am Coll Surg. 1998 Dec;187(6):616-9. doi: 10.1016/s1072-7515(98)00258-0.
Recombinant human erythropoietin (rHuEPO) for the treatment of severe anemia in patients with end-stage renal disease (ESRD) is suggested to improve rehabilitation and cognitive function. The criticism is the alleged increase in the failure rate of arteriovenous (AV) access grafts and in the incidence of lower-extremity deep venous thrombophlebitis (DVT). This study addressed the longevity of AV grafts and the incidence of DVT.
We reviewed 481 consecutive patients with ESRD on dialysis with PTFE access grafts, including 173 consecutive patients who were receiving rHuEPO and 308 who were not. rHuEPO was administered during dialysis titrated against the hematocrit to achieve a level of 33% to 38%. The rHuEPO-ESRD group included 173 patients with a mean age of 58 years, including 54% women; 84% of the grafts were in the upper extremity. In the control group of 308 patients, 57% were women. Diabetes and hypertension were controlled in both groups.
Forty-five of 173 rHuEPO patients (26%) experienced graft thrombosis within 1 year. Among 88 episodes of thrombosis, 14 patients experienced multiple episodes. Primary patency was 8.9 months; secondary patency was 11.2 months. In the control population, 95 of 308 patients (31%) experienced graft thrombosis; 27 patients had multiple episodes. Primary patency was 7.8 months and secondary patencywas 9.8 months. The hematocrit improved from a mean of 23% in the control group to 34% in the treated rHuEPO group. Two patients in the control group and one patient receiving rHuEPO experienced DVT in the lower extremity.
Primary and secondary AV fistula patency rates were improved by 10% with rHuEPO. rHuEPO did not increase DVT.
重组人促红细胞生成素（rHuEPO）用于治疗终末期肾病（ESRD）患者的严重贫血，被认为可改善康复和认知功能。有人批评其会导致动静脉（AV）通路移植物失败率以及下肢深静脉血栓性静脉炎（DVT）发生率上升。本研究探讨了AV移植物的使用寿命及DVT的发生率。
我们回顾了481例连续接受聚四氟乙烯（PTFE）通路移植物透析的ESRD患者，其中173例连续接受rHuEPO治疗，308例未接受。透析期间根据血细胞比容滴定给予rHuEPO，使血细胞比容达到33%至38%。rHuEPO - ESRD组包括173例患者，平均年龄58岁，其中54%为女性；84%的移植物位于上肢。在308例患者的对照组中，57%为女性。两组患者的糖尿病和高血压均得到控制。
173例rHuEPO患者中有45例（26%）在1年内发生移植物血栓形成。在88次血栓形成事件中，14例患者经历了多次事件。初次通畅时间为8.9个月；二次通畅时间为11.2个月。在对照组中，308例患者中有95例（31%）发生移植物血栓形成；27例患者经历了多次事件。初次通畅时间为7.8个月，二次通畅时间为9.8个月。血细胞比容从对照组的平均23%提高到接受rHuEPO治疗组的34%。对照组有2例患者和1例接受rHuEPO治疗的患者发生下肢DVT。
rHuEPO使AV内瘘的初次和二次通畅率提高了10%。rHuEPO未增加DVT的发生。
