左卡尼汀在血液透析贫血患者中的应用观察

目的 观察维持性血液透析患者在应用重组促红细胞生成素治疗6个月后,贫血仍未达到靶目标值,继而联合应用左卡尼汀的治疗效果。方法将34例维持性血液透析患者随机分为两组,每组各17例。两组均应用重组促红细胞生成素3000U,每周2次,皮下注射。治疗组每次血液透析后予左卡尼汀0．5g静脉注射,对照组静脉注射等量0．9％氯化钠溶液。疗程为12周。观察两组患者治疗前后血红细胞、血红蛋白、血细胞比容、血浆清蛋白的情况。结果治疗组患者红细胞、血红蛋白、血细胞比容、血浆清蛋白上升水平高于对照组（P〈0．05）。结论左卡尼汀能显著提高重组促红细胞生成素对维持性血液透析患者贫血治疗的效果,可以改善维持性血液透析患者营养状况。     

C-反应蛋白与血液透析患者贫血和促红细胞生成素用量的关系

目的探讨维持性血液透析患者C-反应蛋白(CRP)与贫血和促红细胞生成素(EPO)疗效的关系.方法 66例维持性血液透析患者于透析日空腹采血测定血红蛋白(Hb)、红细胞比积(Hct)、血清铁蛋白(SF)、血浆白蛋白(Alb)、CRP,记录重组促人红细胞生成素rHuEPO用量.结果 66例患者中42例(占63.9%)CRP升高为CRP增高组,22例(占36.1%)CRP正常为CRP正常组,CRP增高组rHuEPO用量、CRP水平均高于CRP正常组,Hct、Hb、血浆白蛋白Alb低于CRP正常组.结论 尿毒症血液透析患者CRP水平普遍增高,CRP升高是预测rHuEPO疗效的理想指标,监测CRP水平对调整rHuEPO用量以达到有效纠正贫血有一定临床应用价值.     

Appropriateness of anemia management in hemodialysis patients

The anemia of end stage renal disease (ESRD) is common and often severe complication that can be managed successfully by erythropoiesis-stimulating agents (ESA) administration.AimsTo investigate current practice of anemia management in hemodialysis patients and to assess the appropriateness of anemia management by comparing observed practice to the Kidney Disease Outcomes Quality Initiative (KDOQI) guideline recommendations.Settings and designThe study was conducted at two hemodialysis centers in Riyadh, Saudi Arabia. Data on anemia parameters, comorbidities, ESA dosing and iron supplementation were collected. The data were collected for 7 months retrospectively from April to the end of May 2008 and prospectively from June to October 2008. Patients who were over 18 years of age with ESRD undergoing hemodialysis were included. Patients were excluded if they have cancer or receiving chemotherapy or radiotherapy.ResultsData were collected from 87 patients. Mean Hgb value for those patients was 11.16 ± 0.97 g/dL. Thirty-nine patients (45%) had mean Hgb values between 11.0 and 12.0 g/dL the target range recommended by KDOQI guideline. The mean weekly prescribed dose of erythropoietin was 8099 ± 5946 IU/Week (135 ± 99 IU/kg/Week). Information on ferritin concentrations was available for 48 (55%) patients. The mean serum ferritin concentration for those patients was 693 ± 420.5 ng/mL. Fifty-two patients had transferrin saturation (TSAT) values recorded. The mean TSAT value was 38.5 ± 19.7%. Conclusions: There is an opportunity to improve anemia management in hemodialysis patients particularly thorough evaluation of causes of inadequate response rate and better monitoring and management of iron status.     

左卡尼汀联合促红细胞生成素治疗慢性肾衰竭合并贫血疗效观察

目的观察左卡尼汀对促红细胞生成素治疗肾性贫血疗效的影响。方法将50例尿毒症血液透析患者随机分成治疗组和对照组,两组患者均于血液透析后皮下注射促红细胞生成素,剂量为每周100-150U／kg,待血细胞比容（Hct）上升至30％时后减量。同时治疗组每次血液透析后静脉注射左卡尼汀20-50mg／（kg·次）,疗程12周。结果治疗组的血红蛋白（Hb）、血细胞比容水平显著高于对照组（P〈0.01）。治疗组于治疗后第12周促红细胞生成素用量较治疗前明显减少,而对照组促红细胞生成素用量无明显改变。而两组血压升高发生率差异无统计学意义（P=0.182）。结论左卡尼汀能减少促红细胞生成素的用量及提高其疗效,纠正肾性贫血。     

左卡尼汀对促红细胞生成素治疗血液透析患者肾性贫血疗效的影响

目的 探讨左卡尼汀对促红细胞生成素治疗血液透析患者肾性贫血疗效的影响.方法 将40例进行血液透析治疗（HD）的慢性肾衰尿毒症患者,随机分为治疗组和对照组,每组20例.对照组给予促红细胞生成素9 000 u/周,于血液透析后皮下注射,同时常规口服铁剂、叶酸.治疗组在对照组基础上予左卡尼汀1.0g加入20 ml 0.9％氯化钠注射液静脉缓慢注射3～5 min,每周2次.两组均治疗3个月.治疗前和治疗4周、3个月后检测血红蛋白（Hb）、血细胞比容（Hct）、血清铁蛋白（SF）、血清全段甲状旁腺素（iPHT）并比较.结果 治疗组治疗4周后,Hb、Hct水平较治疗前上升（均P＜0.05）.3个月后两组Hb较治疗前均显著升高（均P＜0.05）,而且治疗组Hb的升高明显优于对照组（P＜0.01）.结论 左卡尼汀能提高促红细胞生成素治疗血液透析患者肾性贫血的疗效.     

C-反应蛋白水平与维持性血液透析老年患者营养状态及贫血的关系

目的评价老年维持性血液透析患者C-反应蛋白（CRP）与营养状态及贫血的关系。方法38例老年及同期42例年轻维持性血液透析患者于透析日空腹采血测定红细胞（RBC）、血红蛋白（Hb）、红细胞压积（Hct）、转铁蛋白（TF）以及血浆白蛋白（Alb）、血肌酐（SCr）、尿素氮（BUN）和CLIP;测定患者肱三头肌皮褶厚度（TSF）、上臂围（AC）、上臂肌围（AMC）等。结果老年维持性血液透析患者TSF、AC、AMC、RBC、Hsb、Hct、TF、BUN、SCr、Alb均显著低于年轻组患者,而CRP水平显著高于年轻组患者（P〈0．05或P〈0．01）;老年患者CRP与Hsb、Hct、Alb呈显著负相关（P〈0．01,P〈0．01,P〈0．05）。结论CRP是反映维持性血液透析患者早期营养不良及炎性反应的敏感指标。     

血液透析患者应用促红细胞生成素治疗贫血的疗效观察及年龄影响因素分析

目的观察促红细胞生成素对血液透析患者贫血的疗效,并按年龄因素对疗效进行分析。方法对238例血液透析贫血患者应用促红细胞生成素3000U支/皮下注射,剂量每周100~150U/kg,分2~3次给药。分析其疗效并与年龄的关系。结果 238例患者中有效224例（94.12%）,无效14例（5.88%）。治疗后238例患者血红蛋白（Hb）、红细胞比容（Hct）、尿素氮（BUN）及肌酐（Cr）水平明显改善（P〈0.01）,贫血改善情况随年龄的增加而下降（P〈0.05或P〈0.01）。对Hb上升值及年龄因素进行Pearson相关分析表明,Hb上升值及年龄因素呈负相关（r=-0.682）。且不良反应轻微。结论促红细胞生成素治疗血液透析患者贫血安全有效,但疗效随年龄增加而下降。     

Potential effects of omega-3 fatty acids on anemia and inflammatory markers in maintenance hemodialysis patients

Background

Anemia is a common complication among hemodialysis (HD) patients. Although intravenous iron and erythropoiesis-stimulating agents revolutionized anemia treatment, about 10% of HD patients show suboptimal response to these agents. Systemic inflammation and increased serum hepcidin level may contribute to this hyporesponsiveness. Considering the anti-inflammatory properties of omega-3 fatty acids, this study aimed to evaluate potential role of these fatty acids in improving anemia and inflammation of chronic HD patients.

Methods

In this randomized, placebo-controlled trial, 54 adult patients with HD duration of at least 3 months were randomized to ingest 1800 mg of either omega-3 fatty acids or matching placebo per day for 4 months. Anemia parameters including blood hemoglobin, serum iron, transferrin saturation (TSAT), erythropoietin resistance index, and required dose of intravenous iron and erythropoietin, and serum concentrations of inflammatory/anti-inflammatory markers including interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-10, C-reactive protein (CRP), hepcidin, ferritin, intact parathyroid hormone (iPTH), and ratios of IL-10 to IL-6 and IL-10 to TNF-α were measured at baseline and after 4 months of the intervention.

Results

45 subjects (25 in the omega-3 and 20 in the placebo group) completed the study. No significant changes were observed in blood hemoglobin, serum iron, TSAT, and required dose of intravenous iron in either within or between group comparisons. Additionally, erythropoietin resistance index as well as required dose of intravenous erythropoietin showed no significant change in the omega-3 group compared to the placebo group. Although a relative alleviation in inflammatory state appeared in the omega-3 group, the mean differences of inflammatory and anti-inflammatory markers between the two groups did not reach statistically significant level except for IL-10-to-IL-6 ratio and serum ferritin level which showed significant changes in favor of omega-3 treatment (P <0.001 and P = 0.003, respectively).

Conclusion

Omega-3 fatty acids relatively improved systemic inflammation of chronic HD patients without any prominent benefits on anemia. However, future well-designed studies on larger number of patients may determine utility of omega-3 fatty acids in HD patients with respect to inflammation and anemia.     

Pharmacokinetics of epoetin in haemodialysis patients after subcutaneous administration: influence of chronic treatment

The purpose of this study was to investigate whether chronic subcutaneous administration of epoetin has an influence on its pharmacokinetics in patients with chronic renal failure and anaemia. 14 Patients were included in the study. The data of 8 patients could be evaluated at the end of the study. All patients were on maintenance haemodialysis. The pharmacokinetic profile of epoetin was studied directly after the first subcutaneous administration of 60 U/kg body weight. Patients were further treated with epoetin to maintain haemoglobin concentration between 6.0 and 6.5 mmol/l. After about one year of treatment the pharmacokinetic profile was studied again, using the same dosage. Between both profiles no significant differences (paired Student's t-test) were found in the pharmacokinetic parameters studied: absorption half-life, time to maximum concentration, maximum concentration, elimination half-life, area under the curve and mean residence time. However, in individual patients large differences may be found.     

血液透析患者的高血压药物控制(英文)

高血压是血液透析患者心、脑血管并发症的重要危险因素。清除体内过量水分,准确评估患者干体重,抗高血压药物治疗是目前比较常用的有效控制透析患者高血压、降低心血管事件发生率和病死率的治疗手段。     

右旋糖酐氢氧化铁在治疗血液透析患者肾性贫血中的应用

目的:评价右旋糖酐氢氧化铁注射液治疗维持性血液透析患者肾性贫血的有效性与安全性.方法:120例维持性血透病人,随机分为静脉组与口服组,分别采用静脉注射右旋糖酐氢氧化铁及口服琥珀酸亚铁进行补铁治疗,总疗程8周.检测治疗前后血清铁及红细胞相关指标并对不良反应进行监测.结果:治疗8周时,静脉组RBC、Hb、Hct、血清铁蛋白(SF)与转铁蛋白饱和度(TSAT)显著升高,幅度明显高于口服组(P＜0.01).静脉组3例有不良反应,1例出现药物相关皮疹,停药后消失,2例轻度胃肠道反应.口服组19例出现明显胃肠道症状.静脉组总不良反应发生率(3/60,5.0%)明显低于口服组(19/60,31.6%),P＜0.01.结论:静脉注射右旋糖酐氢氧化铁可有效纠正维持性血透病人的铁缺乏、提高铁利用率及rHuEPO的治疗效果.且不良反应发生率低、安全性良好.     

维持性血液透析患者营养状态及其影响因素的探讨

目的：通过探讨维持性血液透析患者营养状况并探讨骨代谢毒素对营养不良的影响,为营养不良和肾性骨病的治疗提供依据。方法：入选维持性血液透析患者69例,测定指标,①肾性骨病相关毒素,血清甲状旁腺素（PTH）、血钙、磷：②营养学测定,MQSGA、白蛋白、IGF-1、IGF-BP3、人体指数学测量（BSF、TSF、MAC、MAMC）;③贫血指标,Hb、HCT、转铁蛋白（TF）;④微炎症标志,血清C-反应蛋白（CRP）。结果：血液透析患者营养不良发生率达69.6％;iPTH与MQSGA、ALB、Hb、MAC、MAMC、IGF-1相关性存在统计学意义,P〈0.05;钙磷沉积与MQSGA、ALB、Hb、MAC、MAMC相关,P〈0.05。结论：维持性血液透析患者营养不良发生率高,PTH、钙磷代谢是影响血液透析患者营养状态、蛋白代谢和贫血的重要因素。     

两种补铁途径治疗血液透析患者肾性贫血的临床疗效比较

目的比较不同补铁途径治疗血液透析患者肾性贫血的疗效及安全性。方法选取68例维持性血液透析的慢性肾衰竭（CRF）患者,按数字表格法随机分为两组,每组34例。对照组采用口服补铁,观察组采用静脉补铁,观察比较两组临床疗效。结果观察组总有效率61．76％,明显高于对照组的32．35％（x。=4．781,P=0．029）;两组患者Hb、Het、铁蛋白、转铁蛋白饱和度治疗后均比治疗前明显改善（t=4．931、4．213、5．429、5．107、7．018、6．472、7．821、7．530,均P〈0．05）,观察组较对照组改善显著（t=4．082、3．968、4．395、4．139,均P〈0．05）。结论采用静脉补铁能显著改善血液透析患者贫血状态,明显提高血清铁指标,改善红细胞生成,迅速补充铁储备,纠正肾性贫血。     

补肾养血汤对血液透析患者肾性贫血的疗效

目的观察中药补肾养血汤治疗血液透析患者肾性贫血的临床疗效。方法将76例血液透析治疗的肾性贫血患者随机分成治疗组、对照组。对照组38例予促红细胞生成素治疗并口服铁剂及叶酸,治疗组38例在西医治疗的基础上加用补肾养血汤。观察治疗前后两组血红蛋白、红细胞压积、红细胞及血清白蛋白的变化。结果治疗3个月后,治疗组血红蛋白、红细胞压积、红细胞及血清白蛋白与对照组治疗后及本组治疗前比较,差异均有统计学意义（P〈0.05）。结论补肾养血汤能明显改善血液透析患者的贫血状态。     

维持性血液透析患者透析充分性相关因素分析

目的：探讨维持性血液透析（MHD）患者透析充分性的影响因素。方法以2008年1月至2012年12月南昌大学第一附属医院血液净化中心378例维持性血液透析患者为研究对象。每月监测患者血红蛋白、肌酐、尿素氮等10余项临床指标,计算得出尿素清除指数（Kt/V）和尿素下降率（URR）。用单因素和多因素分析探讨MHD患者透析充分性与临床指标的关系。结果单因素ANOVA分析显示原发病、年龄、血钠、血钾、血总蛋白、尿素氮、iPTH、血磷、血钙与Kt/V有关。而多重线性回归分析显示年龄、每周透析时间、干体重和血红蛋白是Kt/V的独立影响因素。年龄、每周透析时间、干体重与Kt/V呈负相关（P〈0.05）;血红蛋白与Kt/V呈正相关（P〈0.05）。其中年龄是最主要的因素。结论 MHD患者透析充分性与患者年龄、每周透析时间、血红蛋白和干体重密切相关。     

左卡尼丁联合促红细胞生成素治疗维持性血液透析患者肾性贫血

目的观察左卡尼丁联用促红细胞生成素(EPO)对维持性血液透析患者肾性贫血的疗效及EPO用量的影响。方法采用同期随机对照研究,选择2009年3-9月于我院血液净化中心行维持性血液透析的患者共36例,随机分为3组,常规剂量EPO治疗组(A组)12例、小剂量EPO加左卡尼丁治疗组(B组)13例及常规剂量EPO加左卡尼丁治疗组(C组)11例,观察各组方法治疗8周后贫血指标的变化。结果治疗后第4周,各组血红蛋白(Hb)和红细胞压积(Hct)水平均较治疗前升高,但各组之间比较差异无统计学意义(P>0.05);治疗第8周时,各组患者Hb、Hct水平明显上升(P<0.01),但C组患者Hb、Hct高于A、B组(P<0.05);B组患者EPO用量较A组少,但B组患者Hb、Hct水平高于A组,两组比较差异有统计学意义(P<0.05)。结论左卡尼丁与EPO联用可提高治疗维持性血液透析患者肾性贫血的疗效,纠正贫血,减少EPO的用量。     

重组人红细胞生成素在慢性肾衰血透病人贫血中的应用

目的　探讨重组人红细胞生成素 (r HuEPO)治疗慢性肾衰血透病人贫血的临床疗效。方法　给 60例慢性肾衰贫血病人于透析后皮下注射r HuEPO ,并动态观察红细胞计数 (RBC)、红细胞压积 (HCT)、血红蛋白 (Hb)、网织红细胞 (Rc)的变化。结果　病人的贫血症状明显改善 ,RBC、Hb、HCT、Rc与治疗前相比明显增高 (P <0 0 5)。结论　r HuEPO对慢性肾衰血透病人的贫血有可靠疗效     

口服与静注铁剂治疗血液透析患者肾性贫血的疗效比较

目的比较静脉与口服补铁对接受促红素治疗的血液透析患者的疗效。方法口服组给予琥珀酸亚铁，每次200mg每日3次，连续2个月；静脉组给予静脉输注右旋糖酐氢氧化铁，每次100mg，每周2次，共10次。观察治疗前后血红蛋白（Hb）、红细胞比容（Hct）、血清铁蛋白（sF）及转铁蛋白饱和度（TSAT）的变化。结果静脉补铁组治疗后Fib、Hct、SF及TSAT均较口服组明显升高（均P〈0．01）。口服补铁组临床有效率20％，静脉补铁组临床有效率60％。静脉补铁明显优于口服补铁。结论静脉补铁可迅速改善贫血，配合EPO治疗效果明显，从而减少输血，减少医疗费用，应优选。     

Comparison of the therapeutic effects of epoetin zeta and epoetin alfa in the correction of renal anaemia

ABSTRACT

Objective: To assess the therapeutic equivalence of epoetin zeta and epoetin alfa for correction of haemoglobin (Hb) concentration in patients with anaemia and chronic kidney disease (CKD) stage 5 maintained on haemodialysis.

Study design: In total, 609 patients with CKD and anaemia (Hb?<?9?g/dL) were randomly assigned to receive either epoetin zeta or epoetin alfa intravenously, one to three times per week for 24 weeks. Dosing was titrated individually to achieve a stable, target Hb concentration of 11–12?g/dL. Primary endpoints were the mean weekly dose of epoetin per kilogram of body weight and mean Hb concentration during the last 4 weeks of treatment. Safety endpoints were the occurrence of anti-erythropoietin antibodies, ratings of tolerability and adverse events (AEs).

Results: Mean (± standard deviation [SD]) Hb concentration over the last 4 weeks of treatment was 11.61?±?1.27?g/dL for patients receiving epoetin zeta, compared with 11.63?±?1.37?g/dL for patients receiving epoetin alfa (95% confidence interval [CI]: –0.25 to 0.20?g/dL). Mean (± SD) epoetin zeta weekly dose over the last 4 weeks of treatment was 182.20?±?118.11?IU/kg/wk, compared with 166.14?±?109.85?IU/kg/wk for epoetin alfa (95% CI: –3.21 to 35.34?IU/kg/wk). The most commonly reported AEs (> 5% of patients) were infections and infestations (12.5% and 12.8% of patients treated with epoetin zeta and epoetin alfa, respectively) and vascular disorders (8.5% and 8.9%, respectively). No patients developed neutralizing anti-erythropoietin antibodies.

Conclusions: Epoetin zeta, administered intravenously, is therapeutically equivalent to epoetin alfa in the correction of low Hb concentration in patients with CKD undergoing haemodialysis. No unexpected AEs were seen and both epoetin zeta and epoetin alfa were well tolerated.     

Simplifying anemia management in hemodialysis patients: ESAs administered at longer dosing intervals can enhance opportunities to provide patient-focused care

Abstract

Objective:

To review issues and challenges in caring for hemodialysis patients with anemia of chronic kidney disease, specifically focusing on the effects of longer erythropoiesis-stimulating agent (ESA) dosing intervals on processes of care.