Maintenance of target hemoglobin level in stable hemodialysis patients constitutes a theoretical task: a historical prospective study

被引:22
作者
Portoles, Jose M. [1 ,10 ]
de Francisco, Angel L. M. [2 ,10 ]
Gorriz, Jose L. [3 ]
Martinez-Castelao, Alberto [4 ]
Lopez-Gomez, Juan M. [5 ]
Arias, Manuel [2 ,10 ]
de la Cruz, Juan J. [6 ]
Cases, Aleix [7 ,10 ]
Fernandez, Evaristo [8 ]
Aljama, Pedro [9 ,10 ]
机构
[1] Fdn Hosp Alcorcon, Serv Nephrol, E-28922 Madrid, Spain
[2] Hosp Univ Valdecilla, Serv Nephrol, Santander, Spain
[3] Hosp Univ Dr Peset, Serv Nephrol, Valencia, Spain
[4] Hosp Univ Bellvitge, Serv Nephrol, Barcelona, Spain
[5] Hosp Univ Gregorio Maranon, Serv Nephrol, Madrid, Spain
[6] Autonomous Univ Madrid, Dept Prevent Med & Publ Hlth, E-28049 Madrid, Spain
[7] Univ Barcelona, Hosp Clin, Nephrol Unit, Barcelona, Spain
[8] Hosp Puerto Real, Serv Nephrol, Cadiz, Spain
[9] Hosp Univ Reina Sofia, Serv Nephrol, Cordoba, Spain
[10] Inst Salud Carlos III, REDinREN, Madrid, Spain
关键词
erythropoiesis-stimulating agents; darbepoetin; hemodialysis; hemoglobin variability;
D O I
10.1038/ki.2008.524
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Maintenance of target hemoglobin (Hb) values in hemodialysis patients treated with erythropoiesis-stimulating agents (ESAs) remains difficult. We examined Hb variability in the clinical setting in hemodialysis patients. Hemodialysis patients treated with ESAs who maintained the recommended Hb range of 11-13 g per 100 ml over 3 months and were not admitted to hospital, did not require transfusion, and did not experience any major clinical event during this period were followed prospectively for 1 year. Anemia events, Hb variation events (any value out of +/- 1.5 g per 100 ml of the median Hb level in the total follow-up period for the individual patient), risk factors for anemia, and Hb variation events were assessed. We studied 420 patients (63% males, mean age 61 years), 222 received short-acting erythropoietin (EPO) and 198 long-acting darbepoetin. A total of 4654 blood samples (mean 11.1 per patient-year) were analyzed. Only 3.8% of patients were maintained within the target Hb levels (11-13 g per 100 ml) during 1 year. Hb variation events occurred in 20.8% of laboratory values and anemia events in 14.7%, with a median time to the first event of 3 months. Treatment with short-acting EPO (vs long-acting darbepoetin), change of ESA dose in the previous visit, resistance index, and hospitalization were significant risk factors for both anemia events and Hb variation events. Our results show that Hb values are rarely maintained within the recommended guidelines even in more stable hemodialysis patients. Hb variability is frequently associated with clinical events or ESA dose changes. Long-acting darbepoetin achieved better Hb stability than short-acting EPO.
引用
收藏
页码:S82 / S87
页数:6
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