维持性血液透析患者贫血治疗达标情况及其影响因素分析

目的:观察维持性血液透析患者贫血治疗的有效性,并分析贫血治疗的影响因素。方法:选取维持性血液透析≥3个月,持续红细胞生成素(EPO)治疗≥3个月患者200例,EPO剂量100～150 Iu.kg-1.W-1,每月监测患者血常规,每3个月监测患者血甲状旁腺素(PTH)、透前透后生化、铁指标,根据检验结果及时调整透析方案、EPO剂量、补铁方案及营养指导。记录患者最近一次血红蛋白、PTH、白蛋白、二氧化碳结合力、铁蛋白、转铁蛋白饱和度指标,统计血透患者贫血达标情况,分析贫血与PTH、白蛋白、二氧化碳结合力、铁蛋白、转铁蛋白饱和度的关系。结果:患者贫血达标率(Hb≥110 g/L)49%(98/200),100 g/L≤Hb<110 g/L之间21%(42/200),Hb<100 g/L有30%(60/200)。将患者分为治疗达标组(Hb≥110 g/L组)和治疗未达标组(Hb<110 g/L组)。未达标组PTH、铁蛋白较达标组高,但差异无统计学意义(P>0.05),二氧化碳结合力两组差异无统计学意义(P>0.05),血白蛋白、转铁蛋白饱和度则达标组高于未达标组,差异存在统计学意义(P<0.05)。结论:血液透析患者贫血达标率49%,与患者原发病、基础疾病、营养状况、血白蛋白、缺铁状态等因素密切相关,与PTH、酸中毒、铁蛋白水平无关。     

前白蛋白与维持性血液透析患者死亡的关系

目的探讨前白蛋白与维持性血液透析(MHD)患者死亡的关系。 方法回顾分析了2012年1月至2018年6月北京民航总医院行维持性血液透析(透析龄≥3月)的患者的一般情况、生化指标以及预后;以死亡患者为研究组,存活患者为对照组;以t检验、非参数检验、χ²检验将两组患者数据进行比较,并使用Logistic回归分析的方法分析与MHD患者全因死亡相关的危险因素。 结果①纳入研究患者325例,平均年龄(63.4±13.4)岁,透析龄64.0(41.5±98.5)月,存活组210例、死亡组115例,死亡原因主要包括感染(24%)、心血管疾病(17%)、脑血管疾病(16%)、恶液质(12%)、肿瘤(10%)等。②死亡组白蛋白、前白蛋白、血肌酐、尿素氮、血磷、全段甲状旁腺激素均明显低于存活组(P<0.05);CRP(Z＝－5.824)、透析龄(Z＝－2.827)及年龄(t＝7.672)明显高于存活组(P<0.05)。男性与女性的死亡率无明显差别(χ²＝0.274,P>0.05),糖尿病组与非糖尿病组死亡率具有明显差异(χ²＝7.230,P<0.05)。③多因素Logistic回归分析显示年龄、透析龄、是否合并糖尿病、白蛋白、前白蛋白与MHD患者死亡独立相关;白蛋白(OR＝0.854)及前白蛋白(OR＝0.983)是独立保护因素(P<0.05);增龄(OR＝1.046)、透析龄延长(OR＝1.012)、合并糖尿病(OR＝2.201)是独立危险因素(P<0.05)。④前白蛋白与白蛋白正相关(r＝0.609,P<0.001),前白蛋白与其他营养指标相关性比白蛋白强。 结论前白蛋白与白蛋白对MHD患者的死亡具有独立保护作用,在预测MHD患者死亡时至关重要。     

体外红光照射对血液透析患者血磷水平影响的临床研究

目的观察体外红光照射联合血液透析对血液透析患者血磷水平的影响。 方法18例符合入选标准的维持性血液透析患者作为研究对象,随机分为两组,治疗组12例,进行血液透析联合红光照射,对照组6例,进行血液透析联合安慰照射。体外红光照射治疗2 h/次,3次/周,共治疗4周。分别在首次照射前与末次照射后采集血液标本,标本采集时间为透析前、透析1 h、透析2 h,检测患者不同时间血磷水平。同时对两组患者使用的降磷药物及血液净化模式进行对比。对治疗组及对照组患者结果进行统计分析,根据资料分布情况分别采用卡方检验、t检验或非参数检验。 结果两组患者年龄、性别、原发疾病等基本信息差异无统计学意义。治疗组和对照组患者首次红光照射透析前血磷水平差异无统计学意义[(2.16±0.47) mmol/L与(2.44±0.20 )mmol/L,P＝0.202],红光照射治疗4周后,治疗组患者透析前血磷水平显著低于对照组[(2.04±0.40) mmol/L与(2.64±0.30) mmol/L,P＝0.007]。两组患者口服降磷药、口服骨化三醇、血液透析滤过、血液灌流频率无统计学差异。 结论体外红光照射联合血液透析治疗在一定程度上有助于降低血液透析患者血磷水平。     

血液透析患者血红蛋白波动与住院率及病死率的相关性研究

目的评价维持性血液透析患者的血红蛋白变异情况,探讨血红蛋白变异度和住院率/病死率之间的关系。方法回顾性分析2012年6月至2014年6月在首都医科大学附属复兴医院血液净化中心维持性血液透析患者的血红蛋白变异情况,记录入组患者因各种原因住院及全因死亡情况。正态分布的计量资料应用方差分析法,计数资料应用卡方检验。血红蛋白变异度与年龄、透析时间、平均血红蛋白水平等因素的相关性分析应用直线相关。应用Logistic回归分析住院率/病死率的危险因素。结果 105例维持性血液透析患者纳入研究,平均血红蛋白值为(108.39±8.81)g/L,血红蛋白SD值为(11.43±4.62)g/L,95.24%患者在血红蛋白变异度大的分组中。将患者分为门诊组(42例)、住院组(45例)和死亡组(18例),3组的平均年龄分别为(64.02±13.02)岁、(69.44±13.47)岁和(81.44±10.15)岁,透析时间分别为(9.23±6.42)年、(6.80±4.47)年和(4.98±3.00)年,平均血红蛋白值分别为(110.46±7.12)g/L、(108.51±8.12)g/L和(103.29±12.00)g/L,血红蛋白SD值分别为(9.96±3.74)g/L、(11.98±5.29)和(13.47±3.73)g/L,三组间差异有统计学意义。直线相关示血红蛋白变异度与促红细胞生成素剂量调整次数呈正相关(r=0.209,P=0.032)。Logistic回归显示透析时间(P=0.034)、血红蛋白SD值(P=0.004)为影响住院率/病死率的独立危险因素。结论维持性血液透析患者血红蛋白波动为普遍现象,促红细胞生成素剂量调整和血红蛋白变异度相关。血红蛋白高变异为预测住院率/病死率的危险因素。     

单中心腹膜透析患者血红蛋白达标率及相关因素分析

目的通过调查腹膜透析(peritoneal dialysis, PD)患者贫血状况,分析影响血红蛋白(hemoglobin, Hb)达标的因素。方法收集2019年5月1日至9月30日间在安徽医科大学第一附属医院腹膜透析中心规律随访的所有年龄≥18岁且透析龄≥3个月的随访资料完整的PD患者280例,以Hb≥110 g/L为血红蛋白达标标准,分析Hb达标率及影响Hb达标因素。结果 (1)PD患者Hb浓度为(106.08±20.42) g/L,Hb达标率为40.36%,转铁蛋白饱和度、铁蛋白达标率分别为76.78%、38.95%;(2)Hb达标组与未达标组相比,透析龄、每周重组人促红细胞生成素使用剂量、营养评估体质指数(subjective global assessment, SGA)、血磷水平显著低于未达标组(P0.05);达标组血清白蛋白、胆固醇、血钙、血清铁、转铁蛋白饱和度、总肌酐清除率(creatinine clearance rate, Ccr)、残肾Kt/V、残肾Ccr显著高于未达标组(P0.05);(3)高转运组与低平均转运组、高平均转运组相比血红蛋白水平差异具有统计学意义;(4)单因素logistic回归分析显示透析龄1年、高SGA评分、血清白蛋白35 g/L、全段甲状旁腺素(intact parathyroid hormone, iPTH)300 ng/L、血钙2.5 mmol/L、血清铁10.6μmol/L、转铁蛋白饱和度20%、无残余肾功能是PD患者Hb不达标的影响因素;(5)多因素Logistic回归分析结果显示透析龄5年、血清白蛋白35 g/L、iPTH800 ng/L、血清铁10.6μmol/L、转铁蛋白饱和度20%为PD患者贫血的独立危险因素。结论高透析龄、低白蛋白水平、甲状旁腺功能亢进、铁缺乏为PD患者贫血的独立危险因素。     

不同血管通路对维持性血液透析患者微炎症状态及贫血的影响

目的观察临时性/半永久性中心静脉置管、自体动静脉内瘘对维持性血液透析患者微炎症状态与贫血的影响。方法回顾性分析湖北省通城县人民医院肾内科门诊及住院的采用不同血管通路的维持性血液透析患者共76例,按照不同的血管通路分为导管组(临时中心静脉置管-半永久中心静脉置管)、内瘘组(无临时中心静脉置管)和导管-内瘘组(临时中心静脉置管-动静脉内瘘)。每组患者常规每周3次血液透析治疗,比较3组患者纳入研究开始及6个月后透析日清晨空腹血钙、血磷、血红蛋白(hemoglobin,Hb)、血浆白蛋白(albumin,Alb)、血浆前白蛋白(prealbumin,PA)、超敏C反应蛋白(hypersensitive C-reactive protein,hsCRP)、同型半胱氨酸(homocysteine,Hcy)、白细胞介素6(interleukin-6,IL-6)的变化以及促红细胞生成素(erythropoietin,EPO)的用量。结果 3组患者纳入研究开始及6个月后钙磷水平无明显统计学差异。导管组、内瘘组患者纳入研究开始及6个月后炎症因子hs-CRP、IL-6及血Alb、PA、Hb水平及EPO用量无明显变化。而导管-内瘘组患者早期炎症因子hs-CRP、IL-6水平较高,转换为内瘘后炎症因子水平明显下降[(4.12±1.74)比(13.78±0.71),(71.42±26.52)比(131.16±40.28),P0.05)],血Alb、PA、Hb水平上升[(42.15±7.59)g/L比(32.85±3.76)g/L,(0.32±0.09)g/L比(0.22±0.08)g/L,(110.28±10.15)g/L比(94.67±9.73)g/L],EPO用量减少。相关分析显示,患者的hs-CRP、IL-6与Hb呈负相关(r=-0.59,P0.05;r=-0.54,P0.05),与EPO剂量呈正相关(r=0.64,P0.05;r=0.59,P0.05)。结论中心静脉置管较动静脉内瘘增加维持性血液透析患者的微炎症状态,导致EPO用量增加,贫血改善差。     

维持性血液透析患者钙磷代谢紊乱的影响因素及其与肾性贫血的相关性

目的调查我院血液透析中心患者钙磷代谢标志物血钙、血磷、全段甲状旁腺素(intact parathyroid hormone,iPTH)等指标的达标情况,探讨维持性血液透析患者钙磷代谢紊乱的影响因素及其与肾性贫血的关系,以便更好的控制钙磷代谢紊乱并管理贫血。方法研究纳入2010年1月至2015年1月在我院血液透析中心规律行血液透析(透析时间≥3个月)的终末期肾病患者作为研究对象,收集患者年龄、性别、透析时间、透析频率、残余尿量等相关资料及患者血钙、血磷、iPTH、血红蛋白(hemoglobin,Hb)等实验室检查指标,统计我院血液透析中心患者钙磷代谢标志物血钙、血磷、iPTH等各项指标的达标情况。然后分别根据年龄、透析龄、透析频率、残余尿量进行分组,比较各组间钙磷代谢指标的差异性,再分别根据血钙、血磷和iPTH进行分组,采用趋势卡方检验及方差分析比较各组间Hb达标情况。结果①本血液透析中心263例患者中,血钙达标率45.0%,血磷达标率40.1%,iPTH达标率23.7%,与透析预后与实践模式研究第4阶段(Dialysis Outcomes and Practice Pattern Study,DOPPS4)国家达标数据(56.0%、54.5%、32.1%)比较,达标率存在一定差距。②根据透析龄进行分组,透析龄≥3年组平均血钙水平显著高于透析龄3年组平均血钙水平;根据透析频率进行分组,每周2次透析组平均血钙水平显著高于每周≤2次透析组平均血钙水平,血磷水平显著低于每周≤2次透析组。根据残余尿量进行分组,有尿组(尿量≥100 rnl/24 h)钙磷乘积显著低于无尿组。根据年龄分组,年龄45岁组平均血磷水平、iPTH水平、钙磷乘积水平显著低于年龄≤45岁组。③将血钙浓度分为2.1 mmol/L、2.1~2.5 mmol/L、2.5 mmol/L三组。随着血钙增高,Hb达标(≥110 g/L)人数占比越来越大,由38.8%上升至64%,差异有统计学意义(P0.05)。将血磷浓度分为1.13 mmol/L、1.13~1.78 mmol/L、1.78 mmol/L三组,随着血磷增高,Hb达标(110 g/L)人数占比越来越大,由31%上升至53.4%,差异有统计学意义(P0.05)。将血iPTH浓度分为150 ng/L、150~300 ng/L、300 ng/L三组。随着iPTH增高,Hb达标(≥110 g/L)人数占比越来越小,由52.8%下降至36.8%,差异有统计学意义(P0.05)。结论①适当增加透析频率及有效保护残余尿量有助于控制及改善钙磷代谢紊乱。②血钙、血磷浓度上升,有利于维持性血液透析患者Hb的达标。血iPTH浓度上升,不利于维持性血液透析患者Hb的达标。     

山西省维持性血液透析患者贫血发生情况的流行病学调查及相关因素分析

目的了解山西省维持性血液透析(maintenance hemodialysis,MHD)患者贫血的患病率及治疗情况,并研究其影响因素。 方法通过全国血液净化病例登记系统采集2017年山西省网上直报的MHD患者的临床资料,包括基本资料、透析情况、药物治疗情况及实验室指标,以血红蛋白(hemoglobin, Hb)≥110 g/L作为治疗靶目标,整理并分析数据。 结果2017年山西省MHD患者平均Hb水平为(107.2±19.2) g/L,Hb总体达标率为45.7%。红细胞生成刺激剂使用率为97.6%,铁剂使用率为35.5%,其中68.0%的患者使用静脉铁剂。性别分层显示男性Hb达标率好于女性,年龄分层显示随着年龄的增长,Hb达标率呈增高趋势。与Hb未达标组相比,Hb达标组患者男性比例、平均年龄、透析龄、使用进口透析器的人数比例、尿素下降率及尿素清除分数、静脉铁剂使用率、左旋肉碱使用率、碳酸氢根、血白蛋白、甘油三脂较高;原发病为高血压病患者比例、每周红细胞生成刺激剂剂量、转铁蛋白饱和度≤30%患者比例、甲状旁腺素及C反应蛋白较低(均P<0.05)。多因素Logistic回归分析显示,男性、静脉补铁、高血白蛋白为Hb达标的保护因素,而高甲状旁腺素、高C反应蛋白为Hb达标的危险因素。 结论山西省MHD患者Hb总体达标率(Hb≥110 g/L)为45.7%。男性、静脉补铁、高白蛋白可能为Hb达标的保护因素,高甲状旁腺素、高C反应蛋白可能为其危险因素。合理使用静脉铁剂、改善营养状态,纠正炎症反应可提高Hb达标率。     

维持性血液透析患者贫血及相关因素分析

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者血红蛋白(hemoglobin,Hb)达标情况及其相关影响因素。方法选择2014年1月1日至2015年1月1日间在我院血液透析中心规律行血液透析3个月以上的终末期肾脏疾病患者作为研究对象,收集患者的基本资料(年龄、性别、原发病、体质量、透析时间、透析频率、药物使用情况等)和实验室指标(Hb、铁蛋白、血白蛋白、尿素氮、血肌酐等)以及促红细胞生成素(erythropoietin,EPO)及铁剂使用情况;统计本中心患者Hb达标情况,再根据Hb水平进行分组,采用χ~2检验比较各组间Hb达标情况及EPO、铁剂的使用情况,并对EPO剂量采用Pearson线性相关分析,铁剂的使用采用秩相关分析。结果①本次研究共纳入的257例MHD患者中,按Hb≥110 g/L为达标Hb进行统计,达标患者123例(占46.70%),未达标患者134例(占53.3%)。Hb达标率与国内研究相比基本相似,较国际发达国家水平低。将患者按原发病发病率分组,发病率前五位的分别为高血压肾病92例(占35.80%),慢性肾小球肾炎82例(占31.91%),糖尿病肾脏疾病40例(占15.56%),多囊肾病7例(占2.72%),痛风6例(占2.33%);不同原发病之间贫血患病率的差异具有统计学意义(P0.05)。②将患者按Hb值分组,未达标组的EPO使用量较达标组的EPO使用量低[(60.54±50.41)IU·Kg~(-1)·W~(-1)比(136.51±36.32)IU·Kg~(-1)·W~(-1),P0.001],未达标组静脉铁剂使用量比达标组低[(139.01±52.08)mg比(150.00±78.59)mg,P0.001],2组的年龄、体质量、透析时间、铁蛋白、血白蛋白、尿素氮、血肌酐的差异均无统计学意义(P0.05)。根据患者使用铁剂的情况分组,静脉铁剂组和口服铁剂组间Hb水平的差异均无统计学意义(P0.05)。③通过相关分析显示,Hb与EPO剂量呈正相关(r=0.849,P0.01),而与铁剂的使用呈正相关(r=0.196,P0.01)。结论①本血液透析中心MHD患者的贫血治疗达标率为46.7%,与国内研究相比基本相似,较国际发达国家水平低;②使用EPO治疗的MHD患者有着更高的Hb水平和Hb达标率;③使用铁剂的MHD患者中,Hb达标例数比未使用铁剂组高,但使用静脉铁剂组与口服铁剂组间Hb水平差异无统计学意义;④通过相关性分析显示,Hb与EPO剂量呈强正相关,与铁剂的使用呈弱正相关。     

保定地区维持性血液透析糖尿病患者带cuff透析导管相关性血流感染的危险因素研究

目的探讨维持性血液透析糖尿病患者带cuff透析导管相关性血流感染(catheter-related bloodstream infection, CRBSI)的危险因素,为防控透析导管血流感染提供临床依据。方法对本地区2015年3月至2020年3月使用带cuff透析导管行维持性血液透析的150例糖尿病患者临床资料进行回顾性分析,根据有无CRBSI分为感染组与未感染组,对比两组患者性别、年龄、置管时间、空腹血糖、血红蛋白(hemoglobin, Hb)、白蛋白(albumin, Alb)、红细胞计数(erythrocyte count, RBC)、白细胞计数(white blood cell count, WBC)等临床指标,并将筛查出的有意义指标进行多因素logistic回归分析。结果 150例患者中发生CRBSI 26例,发生率为2.4/千导管日;检出病原菌29株,以金黄色葡萄球菌构成比最高(占34.48%),其次是表皮葡萄球菌与铜绿假单胞菌(占13.79%);经单因素方差分析,发现年龄、导管留置时间、空腹血糖、糖化血红蛋白、Hb、Alb与血液透析糖尿病患者发生CRBSI有关(P0.05);经多因素回归分析发现,维持性血液透析糖尿病患者发生CRBSI的主要危险因素有年龄≥65岁(OR=2.731)、导管留置时间90 d(OR=5.627)、空腹血糖≥12 mmol/L(OR=7.035)、糖化血红蛋白≥10%(OR=6.571)、Hb80 g/L(OR=3.469)、Alb35 g/L(OR=5.049)。结论维持性血液透析糖尿病带cuff透析导管患者CRBSI的主要病原菌为金黄色葡萄球菌,其发生的危险因素有年龄大、导管留置时间长、血糖浓度高及Hb、Alb水平低,提示应对高危人群开展积极的防控工作,以降低带cuff透析导管相关血流感染的发生风险。     

Relationship between hemoglobin variability and prognosis in dialysis patients

Objective To investigate the epidemiological characteristics of hemoglobin variability (Hb-Var) in dialysis patients, and to explore the factors related to Hb-Var and the relationship between Hb-Var and patients outcomes. Methods The study enrolled 178 hemodialysis and peritoneal dialysis patients in the Department of Nephrology, Peking University People's Hospital between October 2009 and March 2010. First six months were observation period, and then followed up for 12 months. The Hb-Var was described by residual standard deviation (Res-SD) and fluctuation across threshold of the Hb level. Non-fatal cardiovascular events and mortality were the primary endpoints. Results The Res-SD was (4.74±2.66) g/L in dialysis patients. Most patients fell into groups of high amplitude (HA) and low amplitude low (LAL), with frequency of 29.8% and 33.1% respectively. The related factors of Hb-Var were fluctuation of erythropoietin (EPO) dosage and hemodialysis. Kaplan-Meier survival curve and multivariable adjusted Cox regression indicated that Res-SD had no impact on the primary endpoints. Accumulative time to reach target hemoglobin level was an independent factor related to outcome. Conclusion Hb-Var occurs commonly in dialysis patients. The fluctuation of EPO dosage and dialysis style increase Hb-Var. Accumulative time to reach target hemoglobin level is an independent factor related to patients outcomes.     

Impact of nocturnal home hemodialysis on anemia management in patients with end-stage renal disease

AIM: Anemia is adversely associated with poor uremia control and is an established cardiovascular risk factor in patients with end-stage renal disease (ESRD). Nocturnal home hemodialysis (NHD) is a novel form of renal replacement therapy that offers superior clearance of uremic solutes and improvements in several cardiovascular outcome parameters. We conducted a retrospective cohort study to test the hypotheses that augmenting the dose and frequency of dialysis by NHD would improve hemoglobin (Hb) concentrations and decrease requirement of erythropoietin (EPO) in ESRD patients. METHODS: In 63 patients (mean age: 46 +/- 2 years) receiving NHD (mean duration: 2.1 +/- 0.2 years), Hb, EPO dose, iron saturation, ferritin were determined before and at six monthly repeated intervals after conversion to NHD. For comparison, 32 ESRD patients (mean age: 57 +/- 3 years) who remained on self-care conventional hemodialysis (CHD) were also studied. RESULTS: There were no differences in baseline Hb concentrations, iron saturation, ferritin, or EPO dose between the two cohorts. After transfer from CHD to NHD, there were significant improvements in Hb concentrations (from 115 +/- 2 to 122 +/- 3 (6 months) and 124 +/- 2 (12 months) g/l, p = 0.03) despite a fall in EPO requirement (from 10,400 +/- 1400 to 8500 +/- 1300 (6 months) and 7600 +/- 1100 (12 months) U/week, p = 0.03). In contrast, CHD cohort had no change in EPO requirement (from 8300 +/- 1100 to 8100 +/- 1300 (6 months) and 8600 +/- 1000 (12 months) U/week, p > 0.05) or Hb concentrations (from 110 +/- 2 to 115 +/- 3 (6 months) and 115 +/- 2 (12 months), p > 0.05). There was a higher percentage of ESRD patients who did not require EPO in the NHD cohort (24% vs. 9.4%, p = 0.01). Lower Hb concentrations were noted in the CHD cohort despite higher iron saturation (0.25 +/- 0.01 (NHD) vs. 0.33 +/- 0.02 (CHD), p = 0.02) at the end of follow-up. CONCLUSIONS: Enhancing uremic clearance by NHD resulted in a rise in Hb and a fall in EPO requirement.     

甲状旁腺切除术对血液透析患者合并继发性甲状旁腺功能亢进骨代谢及骨密度的影响

目的 观察甲状旁腺切除术(parathyroidectomy,PTX)对继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)的维持性血液透析患者骨代谢及骨密度(BMD)的影响.方法 26例SHPT患者行PTX.术前及术后1、3、6、12、18、24个月时常规检测血钙、血磷、血清碱性磷酸酶,化学发光法检测血清全段甲状旁腺素(intact parathyroid,iPTH)、骨钙素(OC)、Ⅰ型前胶原氨基末端前肽(PINP)、β胶原蛋白(β-C TX),术前及术后24个月时双能X线法测定腰椎、股骨颈、骨盆各部位骨密度,观察患者甲状旁腺切除术前、术后骨代谢指标及骨密度变化.结果 (1)与术前比较,血清OC水平[(104.49±25.42) μg/L比(695.46±355.62) μg/L,P＜ 0.01]、PINP水平[(248.36±159.38) μg/L比(809.28±283.50) μg/L,P＜0.01]于手术3个月后明显降低,β-CTX水平于手术1个月后明显降低[(1.60±0.64) μg/L比(3.37±1.34) μg/L,P＜0.01].(2)与术前比较,术后24个月时腰椎BMD[(0.88±0.23) g/cm2比(0.78±0.23) g/cm2,P＜0.01]、股骨颈BMD[(0.96±0.19) g/cm2比(0.84±0.24) g/cm2,P＜ 0.01]及腰椎Z评分[(-1.24±0.55)比(-1.66±0.24),P＜0.01]、股骨颈Z评分[(-1.51±0.72)比(-1.93±0.40),P＜0.01]均升高.(3)相关分析显示,术前血清iPTH水平与⊿腰椎Z评分(r=0.584,P=0.002)、⊿股骨颈Z评分(r=0.400,P=0.043)呈正相关,术前血清OC水平与⊿腰椎Z评分(r=0.651,P＜0.001)、⊿股骨颈Z评分(r=0.509,P=0.008)呈正相关.结论 PTX术可以降低患者升高的iPTH、OC、PINP及β-CTX水平,增加骨密度,同时改善多项生化指标,提高患者生活质量.     

超纯透析液对血液透析患者促红素低反应性的影响

目的 探讨超纯透析液对维持性血液透析患者促红细胞生成素低反应性的影响.方法 选择维持性血液透析患者70例,随机分为普通透析液组(CD组,35例)和超纯透析液组(UPD组,35例),随访1年后观察两组超敏C反应蛋白(hs-CRP)和促红细胞生成素抵抗指数(Erythropoietin resistance index,ERI)的差异.结果 ①以ERI为因变量进行多元逐步线性回归分析,显示hs-CRP是ERI最为重要的独立影响因素(R2=0.699,p＜0.001);②随访1年后两组间hs-CRP差异有统计学意义(5.12±2.74 vs 3.77±2.19,P＜0.05),超纯透析液组ERI有明显改善(11.06±5.27 vs 16.42±7.05,p＜0.01).结论 ①C-反应蛋白升高是促红细胞生成素抵抗的独立影响因素;②使用超纯透析液可改善患者炎症状态和促红素低反应性.     

Epidemiological investigation on the prevalence of anemia and the standard-reaching rate of hemoglobin in patients with maintenance hemodialysis in Anhui province

Objective To explore the prevalence of anemia, percentage of patients with hemoglobin (Hb) reaching the guideline target, and its impact factors in maintenance hemodialysis (MHD) patients in Anhui province. Methods Two thousand six hundred and one cases of MHD patients were investigated in hemodialysis centers of 26 hospitals in southern, northern and central Anhui province from January 1st, 2014 to March 31st, 2014. Age, gender and clinical information on renal disease history, duration of dialysis therapy, types of dialysis, medical history, and laboratory results, were collected. The prevalence of anemia, percentage of patients with Hb levels reaching the guideline target (Hb≥110 g/L) and the associated factors of Hb were analyzed. Results (1) Mean Hb concentration was (100.2±28.1) g/L, 82.5% of patients were diagnosed as anemia. The use rate of erythropoietin, intravenous iron and folic acid were 95.2%, 64.3% and 62.0% respectively. (2) Hb≥110 g/L rate was 32.8%. The percentage of patients with Hb≥110 g/L was higher in males than that in females (35.1% vs 29.4%, P=0.002). Patients with high flux dialysis had a higher percentage of Hb≥110 g/L than those with low flux dialysis (39.2% vs 27.9%, P＜0.001). (3) Compared with patients whose Hb≥110 g/L, patients with ＜110 g/L had shorter duration of dialysis therapy, lower albumin, creatinine, triglyceride, calcium, phosphorus, magnesium, and higher hs-CRP, higher usage rates of erythropoietin, intravenous iron and folic acid (all P＜0.05). (4) The 2.10-2.50 mmol/L calcium (OR=0.346, P=0.005), ＞2.50 mmol/L calcium (OR=0.207, P=0.001), ＞41.9 g/L albumin (OR=0.511, P=0.044), 1.11-2.01 mmol/L triglyceride (OR=0.443, P=0.008), ＞2.01 mmol/L triglyceride (OR=0.257, P＜0.001) and ≥7.63 mg/L hs-CRP (OR=1.652, P=0.049) were influence factors causing Hb to fall below. Conclusions There are high prevalence of anemia and low control rate of hemoglobin in MHD patients in Anhui province. Normal-calcium, hypercalcemia, higher albumin and triglyceride are protective factors of Hb target, but higher hs-CRP is its independent risk factors. The rational use of erythropoietin and intravenous iron, high flux dialysis, well nutrition states, correcting of the hypocalcemia and inflammatory state may contribute to improving the hemoglobin levels.     

左卡尼汀联合红细胞生成素治疗心肾贫血综合征

目的 评价左卡尼汀(LC)联合红细胞生成素(EPO)治疗维持性血液透析心肾贫血综合征(CRAS)患者的临床效果.方法 将91例维持性血液透析患者分为LC联合EPO组(A组)35例、EPO组(B组)30例和对照组26例.各组按常规剂量服用琥珀酸亚铁、叶酸和肌肉注射维生素B12.A组于血液透析后以1.0 g LC加入20 ...     

Erythropoietin requirements: a comparative multicenter study between peritoneal dialysis and hemodialysis

BACKGROUND: The management of anemia with erythropoietin (EPO) is important in the global treatment of dialysis patients. There is a general impression that anemia control with EPO is obtained more easily in peritoneal dialysis (PD) patients than in hemodialysis (HD) patients. The EPO administration route has to be the same to compare the two techniques adequately. METHODS: To compare EPO action by subcutaneous (SC) route in HD and PD, 132 stable patients were recruited (HD: 69, PD: 63) from six centers, with adequate dialysis criteria (Kt/V in HD >1.3; weekly Kt/V in PD >1.8). In a cross-sectional study, the EPO dose/week, the number of EPO doses/week, hemoglobin (Hb), ferritin, transferrin saturation index (TS), albumin and intact parathyroid hormone (iPTH) were analyzed. Iron treatment, comorbidity and ACE inhibitors (ACEI) and angiotensin II antagonist (AIIA) treatment were recorded. A multivariate regression model was used in the statistical analysis. RESULTS: The mean Hb level was the same in both groups, HD 11.6 (1.3) g/dL, PD 11.4 (1.4) g/dL, p=0.3. The SC, EPO doses required to obtain the Hb levels were higher in HD than in PD patients, with a difference of 64.3 u/Kg/week, statistically significant in the multivariate regression model (p=0.001, 95% CI 42.6-86.0). The number of EPO doses/week was also higher in HD patients (65% of HD patients with > or = 3 doses, 19% of PD patients with three or more doses, p<0.001). TS was similar in both groups, while ferritin was higher in HD patients, with a higher percentage of HD patients using intravenous (i.v.) iron (HD 77% vs. PD 49%, p=0.001). Serum albumin and iPTH were lower in PD patients (p<0.001 and p=0.04, respectively), but the percentage of patients with intact parathyroid hormone (iPTH) >500 pg/mL was similar in both groups (HD 17%, PD 14%). CONCLUSIONS: With the same administration route, PD patients showed a reduced EPO requirement, and less frequent EPO administration than HD patients, to obtain the same Hb level. No other factors, except those involved in better depuration of erythropoiesis inhibitors in PD, seemed responsible for the different EPO requirements.     

Efficacy,safety and tolerance of continuous erythropoietin receptor activator intravenous administration on anemia correction in dialysis patientswith chronic renal anemia

Objective To evaluate the efficacy, safety and tolerance of continuous erythropoietin receptor activator (CERA) once every 2 weeks intravenous injection on anemia correction in dialysis patients compared to Epoetin?β (EPO?β) administration. Methods An open?label, randomized, parallel, active?control and multi?center clinical trial was performed. All the hemodialysis or peritoneal dialysis patients with chronic renal anemia who had not been treated with erythropoiesis?stimulating agents (ESAs) for at least 8 weeks before entering the treatment phase were randomized (1∶1) to receive either CERA once every 2 weeks intravenous administration (CERA group, n=132) or intravenous EPO?β three times weekly (EPO group, n=133) for 24 weeks including 16?week correction period and 8?week efficacy evaluation period. At week 25, the patients who reached the target Hb (defined as Hb≥110 g/L and increase in Hb≥10 g/L from baseline without red blood cell transfusion during the 24 weeks after the first dose) were kept on CERA or EPO?β treatment regimen for the subsequent 28 weeks to evaluate the long?term safety and tolerability. The starting dose of CERA was 0.4 μg/kg. Two primary endpoints were (1) the Hb response rate during the first 24 weeks; and (2)the mean change in Hb between the baseline and the evaluation periods (week 17 to week 24). Results Totally 232 patients (87.5%) completed the first 24?week treatment and 198 patients (74.7%) completed the whole study treatment (52 weeks). The response rate in CERA group during the first 24 weeks was 87.12%[95% CI（80.2% to 92.3%）]. Since the lower limit of the 95%CI was greater than 60% (P＜0.01), CERA once every 2 weeks intravenous administration was considered as effective in correction of renal anemia. The difference between CERA group and EPO group in mean change of Hb from evaluation periods to baseline in the per?protocol (PP) population was -4.7 g/L [95%CI (-7.38 g/L to -1.92 g/L)]. Since the lower limit of 95%CI was greater than the pre?defined non?inferiority margin -7.5 g/L (P=0.0205), CERA was considered as non?inferior to EPO in the maintenance of Hb after anemia correction. The Hb level remained stable during the subsequent 28?week extension period in both CERA and EPO groups. During the whole study period, the overall safety findings were similar in CERA and EPO groups, 50.0% and 54.6% of patients experienced at least one adverse event (AE) respectively. The findings from AEs were in accordance with the characteristics of the studied population. Conclusions Intravenous CERA once every 2 weeks is safe and effective for correcting anemia in dialysis patients. Treatment with CERA once every 2 weeks is also non?inferior to 3 times weekly EPO in maintaining the Hb level after the correction. In general, long?term intravenous administration of CERA is well tolerated by dialysis patients with chronic renal anemia.     

Telehealth-based dialysis registration system for the improvement of renal anemia in maintenance hemodialysis: multicenter experiences

Objective To analyze the role of telehealth-based dialysis registration systems in real-time and dynamic reflection of renal anemia in hemodialysis (HD) patients, and discuss the prospect of its application in dialysis registration management. Methods The Red China project was to build up a dialysis registration system based on the WeChat mobile terminal platform. Demographic and baseline laboratory parameters such as age, gender, primary disease, dialysis age, creatinine were recorded in this system. Hemoglobin (Hb) level was monthly recorded. The platform generated Hb statistics report for each HD center monthly, including the detection rate, target rate and the distribution level of Hb, and released it to physicians through the WeChat terminal of mobile phone. After that, physicians could change the treatment of anemia individually on basis of this report. Here the demographic and baseline laboratory parameters, the detection rate, target rate, the average level and the distribution of Hb from June 2015 to October 2017 after the project launched were analyzed. Results From June 2015 to October 2017, 8392 maintenance HD patients from 28 HD centers in Shanghai were enrolled, of whom 5059(60.3%) were male.The average rate age was (60.5±13.7) years old. Baseline average Hb was (108.3±16.0) g/L. Baseline detection rate and target rate were 54.2% and 47.5%, respectively. After 28 months follow-up, the detection rate of Hb increased from 54.2% to 73.6% (P＜0.001), the target rate of Hb increased from 47.5% to 56.1% (P＜0.001), and the level of average Hb rose from (108.3±16.0) g/L to (110.7±16.0) g/L. The difference between average Hb in two consecutive months was less than 1.3 g/L. Conclusions The telehealth-based dialysis registration system can timely report the anemia situation of HD patients, which may improve the awareness rate of anemia, the degree of attention and the compliance of anemia monitoring, so as to improve the detection rate and target rate of Hb and reduce the fluctuation of Hb, which helps to maintain the HD patients to correct anemia in a timely, stable and long-term way. The telehealth-based dialysis registration system, as an improved mode of dialysis registration is a promising way for long-term management of renal anemia in dialysis patients.     

Effects of different treatment methods on renal anemia in maintenance hemodialysis patients with hyperparathyroidism secondary to uremia

Objective To observe the effects of three treatment methods on renal anemia in maintenance hemodialysis patients with hyperparathyroidism secondary to uremia and analyze the influencing factors of erythropoietin (EPO) dosage. Methods A total of 55 maintenance hemodialysis patients with secondary hyperparathyroidism at the hemodialysis center of Huashan Hospital affiliated to Fudan University from January 2015 to December 2016 were retrospectively divided into three groups according to different treatment methods, parathyroidectomy +forearm transplantation group (surgery group, n=16), cinacalcet treatment group (n=6), and calcitriol treatment group (n=33), respectively. The hemoglobin level and erythropoietin dosage were measured before treatment and in the 3rd month, the 6th month and the 12th month after treatment. The changes of hemoglobin and erythropoietin dosage in the three groups before and after treatment were observed, and the mixed effect model was used to analyze the difference of the change of hemoglobin and erythropoietin dosage among three groups. Multiple linear regression analysis was used to analyze the influencing factors of EPO dosage after one year. Results The levels of intact parathyroid hormone (iPTH) in the surgery group and the cinacalcet group before treatment were significantly higher than that in the calcitriol group (both P＜0.05). In the 12th month after treatment, the levels of iPTH decreased significantly in the patients of surgery group and the cinacalcet group compared with those before treatment (both P＜0.05). The levels of serum alkaline phosphatase, serum calcium and serum phosphorus in the surgery group also decreased significantly compared with those before treatment (all P＜0.05). The mixed effect model analysis showed that the hemoglobin level of surgery group was on an upward trend after the treatment, and the overall level was significantly higher than cinacalcet and calcitriol treatment group (P=0.007). There was no significant difference in the dosage change of erythropoietin (EPO) in the three groups over time. However, the intra-group comparison of the mixed effect model showed that the dosage of EPO in the 12th month was significantly lower than that of before the treatment in surgery group (P=0.007). Multiple linear regression analysis showed that dialysis vintage (B=-0.064, P=0.012) and ferritin ≥ 500 μg/L (B=0.645, P=0.032) were independent influencing factors of EPO dosage. The longer the dialysis vintage, the less EPO dosage, and more EPO dosage were observed in patients with ferritin ≥ 500 μg/L. Conclusions Parathyroidectomy and forearm transplantation is more effective in reducing EPO dosage and improving renal anemia in maintenance hemodialysis patients with secondary hyperparathyroidism. Dialysis vintage and ferritin are independent influencing factors for the dosage of EPO.