Relationships among the Dosage of Erythropoiesis-Stimulating Agents, Erythropoietin Resistance Index, and Mortality in Maintenance Hemodialysis Patients

被引：10

作者：

Pan, Sai ^{[1
]}

Zhao, De-Long ^{[1
]}

Li, Ping ^{[1
]}

Sun, Xue-Feng ^{[1
]}

Zhou, Jian-Hui ^{[1
]}

Song, Kang-Kang ^{[1
]}

Wang, Yong ^{[1
]}

Miao, Li-Ning ^{[2
]}

Ni, Zhao-Hui ^{[3
]}

Lin, Hong-Li ^{[4
]}

Liu, Fu-You ^{[5
]}

Li, Ying ^{[6
]}

He, Ya Ni ^{[7
]}

Wang, Nian-Song ^{[8
]}

Wang, Cai-Li ^{[9
]}

Zhang, Ai-Hua ^{[10
]}

Chen, Meng-Hua ^{[11
]}

Yang, Xiao-Ping ^{[12
]}

Deng, Yue-Yi ^{[13
]}

Shao, Feng-Min ^{[14
]}

Fu, Shu-Xia ^{[15
]}

Fang, Jing-Ai ^{[16
]}

Cai, Guang-Yan ^{[1
]}

Chen, Xiang-Mei ^{[1
]}

机构：

[1] Chinese Peoples Liberat Army Gen Hosp, PLA Med Coll, Natl Clin Res Ctr Kidney Dis, Dept Nephrol,Chinese PLA Inst Nephrol,State Key L, Beijing, Peoples R China

[2] Second Hosp Jilin Univ, Dept Nephrol, Changchun, Peoples R China

[3] Shanghai Jiao Tong Univ, Renji Hosp, Shanghai Peritoneal Dialysis Res Ctr, Dept Nephrol,Sch Med, Shanghai, Peoples R China

[4] Dalian Med Univ, Dept Nephrol, Affiliated Hosp 1, Dalian, Peoples R China

[5] Cent South Univ, Dept Nephrol, Xiangya Hosp 2, Changsha, Peoples R China

[6] Hebei Med Univ, Kidney Dis Res Ctr Hebei Prov, Dept Nephrol, Hosp 3, Shijiazhuang, Hebei, Peoples R China

[7] Third Mil Med Univ, Daping Hosp, Inst Surg Res, Dept Nephrol, Chongqing, Peoples R China

[8] Shanghai Jiao Tong Univ, Affiliated Peoples Hosp 6, Dept Nephrol, Shanghai, Peoples R China

[9] Baotou Med Coll, Dept Nephrol, Affiliated Hosp 1, Baotou, Peoples R China

[10] Peking Univ Third Hosp, Dept Nephrol, Beijing, Peoples R China

[11] Ningxia Med Univ, Dept Nephrol, Gen Hosp, Yinchuan, Ningxia, Peoples R China

[12] Shihezi Univ, Dept Nephrol, Affiliated Hosp 1, Sch Med, Shihezi, Peoples R China

[13] Shanghai Univ Tradit Chinese Med, Longhua Hosp, Dept Nephrol, Shanghai, Peoples R China

[14] Henan Prov Peoples Hosp, Dept Nephrol, Zhengzhou, Peoples R China

[15] Hebei Med Univ, Dept Nephrol, Hosp 2, Shijiazhuang, Hebei, Peoples R China

[16] Shanxi Med Univ, Dept Nephrol, Hosp 1, Taiyuan, Peoples R China

来源：

BLOOD PURIFICATION | 2022年 / 51卷 / 02期

基金：

国家重点研发计划; 中国国家自然科学基金;

关键词：

Anemia; Hemodialysis; Erythropoiesis-stimulating agents; Mortality; CHRONIC KIDNEY-DISEASE; ALL-CAUSE MORTALITY; DIALYSIS OUTCOMES; ANEMIA MANAGEMENT; PRACTICE PATTERNS; PROPENSITY-SCORE; ASSOCIATION; HEMOGLOBIN; MORBIDITY; SURVIVAL;

D O I：

10.1159/000506536

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Erythropoiesis-stimulating agents (ESAs) constitute an important treatment option for anemia in hemodialysis (HD) patients. We investigated the relationships among the dosage of ESA, erythropoietin resistance index (ERI) scores, and mortality in Chinese MHD patients. Methods: This multicenter observational retrospective study included MHD patients from 16 blood purification centers (n = 824) who underwent HD in 2011-2015 and were followed up until December 31, 2016. We collected demographic variables, HD parameters, laboratory values, and ESA dosages. Patients were grouped into quartiles according to ESA dosage to study the effect of ESA dosage on all-cause mortality. The ERI was calculated as follows: ESA (IU/week)/weight (kg)/hemoglobin levels (g/dL). We also compared outcomes among the patients stratified into quartiles according to ERI scores. We used the Cox proportional hazards model to measure the relationships between the ESA dosage, ERI scores, and all-cause mortality. Using propensity score matching, we compared mortality between groups according to ERI scores, classified as either > or <= 12.80. Results: In total, 824 patients were enrolled in the study; 200 (24.3%) all-cause deaths occurred within the observation period. Kaplan-Meier analyses showed that patients administered high dosages of ESAs had significantly worse survival than those administered low dosages of ESAs. A multivariate Cox regression identified that high dosages of ESAs could significantly predict mortality (ESA dosage >10,000.0 IU/week, HR = 1.59, 95% confidence intervals (CIs) (1.04, 2.42), and p = 0.031). Our analysis also indicated a significant increase in the risk of mortality in patients with high ERI scores. Propensity score matching-analyses confirmed that ERI > 12.80 could significantly predict mortality (HR = 1.56, 95% CI [1.11, 2.18], and p = 0.010). Conclusions: Our data suggested that ESA dosages >10,000.0 IU/week in the first 3 months constitute an independent predictor of all-cause mortality among Chinese MHD patients. A higher degree of resistance to ESA was related to a higher risk of all-cause mortality.

引用

页码：171 / 181

页数：11

共 45 条

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