两种铁剂治疗慢性肾功能衰竭贫血的对照研究

目的探讨适合于我国实际情况的铁剂治疗慢性肾功能衰竭贫血的方法。方法 41例维持性血液透析患者随机分为两组 ,分别口服右旋糖酐铁和肌肉注射聚麦芽糖氢氧化铁 ,两组均使用促红细胞生成素。结果在治疗后第 6、12周两组患者血红蛋白、红细胞压积、血清铁蛋白、血清铁和转铁蛋白饱和度水平比治疗前有显著提高 ,肌肉注射铁剂组比口服铁剂组指标升高更明显 ,差别有显著性。结论肌肉注射聚麦芽糖氢氧化铁治疗慢性肾功能衰竭贫血效果优于口服铁剂 ,是一经济、实用的补铁方法     

生血宁片治疗维持性血液透析患者贫血的临床观察

目的比较生血宁片和多糖铁复合物胶囊两种口服铁剂在治疗维持性血液透析患者肾性贫血中的治疗效果。方法 2008年12月2010年6月间选择40例维持性血液透析贫血患者,随机分为生血宁片组和多糖铁复合物胶囊组,每组20例,观察期为8周。分别检测两组患者用药前及用药后4、8周时血红蛋白、红细胞压积、血清铁蛋白、转铁蛋白饱和度等指标情况。同时两组患者均使用基因重组人促红细胞生成素,按100～120U/（kg.周）,分两次皮下注射。结果治疗前两组指标无明显差异,治疗后两组患者的血红蛋白、红细胞压积、血清铁蛋白以及转铁蛋白饱和度较治疗前均显著上升,且两组患者升高的幅度相比,生血宁组升高的幅度更显著。治疗结束时,两组患者不良反应方面的差异无统计学意义。结论两种口服铁剂均能有效地纠正血液透析患者的铁缺乏及贫血状况;生血宁片组的作用更显著,且还具备降低患者促红细胞生成素使用量的作用。     

网织红细胞血红蛋白含量在终末期肾病贫血治疗中的意义

目的　探讨网织红细胞血红蛋白含量 (CHr)在应用促红细胞生成素的终末期肾病 (ESRD)贫血患者补铁治疗中的指导意义。方法　对确诊ESRD的透析患者常规使用促红细胞生成素治疗贫血 ,分别以CHr和铁蛋白及转铁蛋白饱和度 (TSAT)作为铁指标指导补铁 ,比较两组的疗效。结果　CHr组与铁蛋白组疗效无显著性差异 ,但前者使用的铁剂剂量小于后者 (5 86 .14± 2 9.5 4比 5 2 8.99± 39.6 7,P <0 .0 5 )。结论　以CHr作为铁指标指导ESRD透析患者的补铁治疗具有安全、稳定、简便的优点。     

肾性贫血时静脉与口服铁剂的疗效比较

慢性肾衰竭(CRF)肾性贫血患者,缺铁十分常见,它不仅加重贫血而且影响促红细胞生成素(EPO)的疗效,以往常用口服铁剂,现又推荐静脉补铁.目的以同一组24例血液透析患者,先用口服铁剂(琥珀酸亚铁,即速力菲),后用静脉铁剂(右旋糖酐氢氧化铁,即科莫非),以观察二种方法对纠正缺铁和改善贫血的效果及副作用.方法口服琥珀酸亚铁,每次200mg每日3次,连续2月,停药2月;以后同组患者再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)、红细胞压积(Hct)、血清铁蛋白(SF)及转铁蛋白饱和度(TSAT),以及静脉补铁后Hb、Hct、SF、TSAT的动态变化.结果口服补铁组临床有效率21%,胃肠道副作用明显(10/24,占41.67%),纠正缺铁的维持时间短.静脉补铁组有效率70.8%,副作用少(胃肠道副作用1/24,占0.04%;轻度肌肉痛1/24,占0.04%),纠正缺铁的维持时间长.结论 CRF贫血患者静脉补铁优于口服补铁.     

静脉补铁联合维生素E对血液透析患者贫血的疗效及氧化应激的影响

目的 探讨抗氧化剂维生素E(VitE)联合静脉用蔗糖铁治疗维持性血液透析患者肾性贫血的疗效及对氧化应激的影响.方法 选择维持性血液透析(MHD)并发肾性贫血患者190例,随机分为A组99例(促红细胞生成素+静脉补铁+口服维生素E)和B组91例(促红细胞生成素+口服补铁),A组静脉用蔗糖铁(前8 w 2次/w;以后1次/w,每次100 mg),同时口服维生素E 200 mg,2次/d,总疗程12 w;B组口服多糖铁复合物胶囊150 mg,1次/d,总疗程12 w,两组患者均同时使用促红细胞生成素,剂量6 000～9 000 IU/w,皮下注射,检测两组患者治疗前后的贫血相关指标,氧化应激指标.结果 治疗12 w后,两组患者血红蛋白(Hb)、红细胞压积(Hct)都有明显升高,但B组相对较慢,两组比较差异有统计学意义,而Ret两组治疗前后差异无统计学意义;血清铁蛋白(SF)两组患者均较治疗前有明显升高,A组更加显著,两组差异有统计学意义(P＜0.05);血浆同型半胱氨酸(HCY)两组治疗前后差异均有统计学意义,A组较B组明显降低,两组治疗前后差异有统计学意义(P＜0.05).结论 静脉使用蔗糖铁同时口服维生素E可有效地纠正MHD患者铁缺乏,能有效改善贫血,且安全性较好,同时可以改善MHD患者因静脉补铁所诱导的氧化应激.     

肾性贫血病人维持性血透中静脉补铁的治疗及相关护理

目的 通过静脉给予右旋糖酐铁(科莫非),使体内有充足的铁储备,从而提高基因重组红细胞生成素(rHuEPO)的治疗效果.方法 34例血液透析病人静脉使用科莫非,每次100mg,每周2～3次,共总剂量1000mg.治疗前后检测血红蛋白,血细胞比容,血清铁蛋白(SF),运铁蛋白饱和度(TSAT),血清总铁结合力(TIBC)及CRP.结果 经过静脉铁剂的治疗,两组病人的Hb和Hct均有不同的程度的升高(P＜0.01),两组血清铁蛋白和转铁蛋白饱和度均较治疗前升高(P＜0.01);在透析患者补铁时给予相应的护理干预,可及时发现过敏反应和延迟反应的发生并及时处理.结论 透析病人补铁治疗有助于改善透析病人的肾性贫血,良好的护理可以确保补铁治疗的顺利进行.     

维持性血液透析患者血红蛋白水平分析及相关因素探讨

目的研究维持性血液透析(maintenancehemodialysis,MHD)患者血红蛋白水平变化并对其相关因素进行探讨,观察促红细胞生成素、右旋糖酐铁注射液、左旋卡尼汀注射液等联合治疗对改善MHD患者贫血的疗效。方法选择上海市闸北区中心医院血液净化中心透析龄超过3个月的MHD患者60例,血红蛋白<90g/L,有绝对缺铁或功能性缺铁,将患者随机分成3组,A组:(促红细胞生成素 口服补铁);B组:(促红细胞生成素 静脉补铁);C组:(促红细胞生成素 静脉补铁 静脉左旋卡尼汀注射液)。进行为期12周的治疗随访,分别检测血红细胞、血红蛋白、网织红细胞、血清铁蛋白、转铁蛋白饱和度、白蛋白、肉碱浓度以及透析充分性(Kt/V)和蛋白分解代谢率(PCR)。结果①3组治疗后血红蛋白都有升高,A组在治疗后血红蛋白升高相对较慢(P<0.05),B组第4周末较治疗前血红蛋白就有明显升高(P<0.05),C组在第4周末血红蛋白较治疗前就出现明显升高持续升高至第12周(P<0.01),并与同期A、B组比较差异有显著性(P<0.01,P<0.05);②治疗至第4周时B、C组网织红细胞较治疗前明显升高(P<0.05),但以后又逐渐降低,至第12周各组网织红细胞变化相对治疗前无明显差异(P>0.05)。③A组铁蛋白、白蛋白、肉碱浓度较治疗前无明显变化(P>0.05);B组铁蛋白较治疗前显著升高(P<0.01)白蛋白、肉碱浓度稍有升高,但差异无显著性(P>0.05);C组铁蛋白较治疗前显著升高(P<0.01),在治疗后第4周末白蛋白、肉碱浓度就升高较明显(P<0.01)。④3组Kt/V治疗前后无明显变化(P>0.05),C组PCR值较治疗前明显上升(P<0.05)。结论各治疗组均能改善MHD患者的贫血状态,口服补铁(A组)与静脉补铁(B组)相比起效较慢,用左旋卡尼汀注射液联合静脉补铁(C组)改善贫血疗效明显。     

促红细胞生成素治疗106例肾性贫血网织红细胞血红蛋白含量变化探讨

目的探讨106例肾性贫血患者应用促红细胞生成素,网织红细胞血红蛋白含量(CHr)变化来指导治疗的临床意义。方法选择肾性贫血的患者使用人重组促红细胞生成素(EPO)治疗,分别以网织红细胞血红蛋白含量(CHr)和铁蛋白(SF)及转铁蛋白饱和度(TSAT)确认铁缺乏指标指导补铁,2组间的疗效比较;观察两组患者在补铁治疗前后CHr、MCH、MCV、RDW、MCHC检测结果的变化。结果 (1)2组CHr与SF检测水平比较,差异无统计学意义(P0.05),但前者使用的铁剂剂量小于后者(527.34±37.67比583.54±30.84,P0.05);(2)CHr在补铁治疗第7天后出现显著治疗效果(P0.01)。结论CHr作为铁缺乏指标,在肾性贫血患者的补铁剂量具有更安全、稳定、简便的优点。     

大剂量静脉补铁联合促红细胞生成素纠正腹膜透析患者肾性贫血的效果观察及护理

目的:探讨大剂量静脉补充铁剂联合促红细胞生成素纠正腹膜透析患者肾性贫血的临床效果及护理措施。方法:将200例长期腹膜透析致肾性贫血的患者随机分为对照组与观察组各100例。对照组采用口服琥珀酸亚铁片(速力菲)治疗,观察组采用大剂量静脉补铁右旋糖酐铁(科莫非)治疗;疗程均为2个月,均同时使用基因重组人红细胞生成素(EPO)10 000 U/周,皮下注射。观察比较两组临床疗效、输注安全性及不良反应情况,并实施积极护理。结果:治疗后两组患者血红蛋白、红细胞计数、红细胞压积、血清铁、血清铁蛋白、转铁蛋白饱和度各项指标均有显著升高(P0.05),且观察组改善程度明显优于对照组(P0.05)。在透析患者补铁时,严密观察和及时给予相应护理干预,使副反应明显下降。结论:大剂量静脉注射科莫非联合EPO纠正腹膜透析致肾性贫血患者临床效果比口服铁剂疗效好,在合理应用的同时,应密切观察,给予相应护理措施,能降低不良反应,以确保补铁治疗的顺利进行,值得临床推广应用。     

肾性贫血患者血液透析中不同静脉补铁方法效果比较

目的观察慢性肾功能衰竭并发肾性贫血患者在血液透析中2种静脉给予蔗糖铁方法的临床效果,探讨静脉补铁的最佳方式。方法将70例慢性。肾功能衰竭维持性血液透析并发肾性贫血的患者随机分为两组各35例,在血液透析过程中分别进行动脉端泵前静脉滴注蔗糖铁和静脉端微量泵静脉注射蔗糖铁,均为2次,周,100mg／次,总剂量1000mg。两组患者均常规使用基因重组红细胞生成素治疗,每周剂量为120～200U／kg,在整个试验过程中保持剂量不变。治疗前、治疗结束后2周检查两组患者血清铁蛋白、血红蛋白、红细胞压积,并进行比较。结果两组患者静脉补铁总剂量1000mg治疗结束后2周,血清铁蛋白、血红蛋白、红细胞压积都较治疗前有明显升高,差异有统计学意义（P〈0．001）;两组患者各指标升高的幅度差异无统计学意义（P〉0．05）。结论动脉端泵前静脉滴注、静脉端微泵静脉注射蔗糖铁都可应用于血液透析中静脉补铁,效果相当,但动脉端泵前静脉滴注方法只需使用静脉输液器,与使用微量泵比较,更适合血液透析过程中多例患者同时静脉补铁的应用,更能节省护理人力。     

静脉注射右旋糖酐铁治疗腹透患者肾性贫血的应用价值

目的：观察静脉注射右旋糖酐氢氧化铁治疗连续性不卧床腹膜透析（CAPD）的慢性肾衰患者铁缺乏的有效性与安全性.方法：采用静脉注射右旋糖酐氢氧化铁和琥珀酸亚铁口服补铁,观察血红蛋白（Hb）,红细胞压积（Hct）,血清铁蛋白（SF）,转铁蛋白饱和度（TS）及肝肾功能、电解质的变化.结果：静脉注射右旋糖酐氢氧化铁可以显著提高CAPD患者的Hb,Hct,TS,SF,效果优于口服琥珀酸亚铁组,无明显副作用.结论：静脉注射右旋糖酐氢氧化铁治疗CAPD患者铁缺乏,改善肾性贫血安全有效.     

静脉与口服铁剂治疗肾性贫血疗效的临床观察

目的:观察慢性肾功能不全患者静脉和口服补铁治疗肾性贫血的疗效、不良反应的发生情况以及对促红细胞生成素(EPO)使用效应的比较。方法:将62例肾性贫血患者随机分为静脉组和口服组,每组31例,观察期10周。所有患者均常规使用EPO治疗,剂量为100U/(kg·周),皮下注射,若患者血红蛋白(Hb)达100g/L,则将EPO剂量减少50%;若患者Hb达120g/L则将EPO剂量减少75%。口服组给予富马酸铁口服,静脉组给予蔗糖铁注射液静脉滴注。观察用药前、用药后4周、用药后8周、用药后10周的血红蛋白(Hb)、红细胞压积(Hct)、铁蛋白(SF)、不良反应以及EPO使用量。结果:治疗后两组患者的Hb、Hct、SF均较治疗前有明显升高,而静脉组升高幅度显著高于口服组(P<0.05),两组患者EPO使用量在治疗后较治疗前均有所减少,而静脉组减少明显(P<0.05),静脉组不良反应的发生率明显低于口服组,EPO的效应明显高于口服组。结论:静脉补铁能及时有效地补充肾性贫血患者所需的铁剂,使贫血状况改善,不良反应少,可安全应用,并能增强EPO效应,减少其用量。     

MCV as a guide to phlebotomy therapy for hemochromatosis

BACKGROUND: A multitude of recommendations exist for laboratory assays to monitor the pace and endpoints of phlebotomy therapy for hemochromatosis. All of these recommendations rely on an assessment of storage iron to guide treatment, and none have been prospectively evaluated. STUDY DESIGN AND METHODS: Nine consecutive patients underwent serial monitoring of Hb, MCV, transferrin saturation, and ferritin during weekly phlebotomy to deplete iron stores (induction therapy) and less frequent sessions to prevent iron reaccumulation (maintenance therapy). Changes in MCV and Hb were used to guide the pace of phlebotomy over a median of 7 years of follow-up. RESULTS: During induction therapy, the MCV increased transiently because of reticulocytosis and then stabilized for a prolonged period before decreasing more sharply, which reflected iron-limited erythropoiesis. Iron depletion was achieved after a median of 38 phlebotomies and removal of 9.0 g of iron. Maintenance phlebotomy was targeted to maintain the MCV at 5 to 10 percent below prephlebotomy values and the Hb at >13 g per dL. Transferrin saturation fluctuated considerably during treatment, but remained below 35 percent during MCV-guided maintenance therapy. Ferritin values were not useful guides to the pace of phlebotomy. The median maintenance therapy phlebotomy interval was 7.5 weeks (range, 6-16), which corresponded to an average daily iron removal of 35 to 67 microg per kg. Most patients showed evidence of iron reaccumulation at phlebotomy intervals of 8 weeks or more. CONCLUSION: The MCV is an inexpensive, precise, physiologic indicator of erythropoietic iron availability. When used in conjunction with the Hb, it is a clinically useful guide to the pace of phlebotomy therapy for hemochromatosis.     

Serum resistin as a novel marker of erythropoietin resistance in nondiabetic patients on hemodialysis

The use of higher erythropoietin (EPO) doses is associated with an increased risk of an adverse outcome and increased mortality in patients with renal failure. Resistin is related to heart disease, and may contribute to an increased atherosclerotic risk. We hypothesized that a link between resistin and EPO responsiveness may exist. We therefore investigated the relationship between resistin and the EPO resistance index (ERI) in nondiabetic hemodialysis (HD) patients. Fifty-seven patients enrolled in the study underwent HD for ≥ 3 months and intravenous EPO therapy to maintain a target hemoglobin (Hb) level of 11.0 g/dl. The ERI was defined as the weekly EPO dose per unit Hb per body weight. The mean patient age was 52.6 ± 11.9 years and the mean time on dialysis was 4.9 ± 4.4 years. Serum Hb and ERI were 10.4 ± 0.7 g/dl, and 13.3 ± 7.0 (IU/kg/week/g/dl), respectively. Serum resistin levels were 23.6 ± 9.3 μg/L. EPO resistance is associated with low body mass index (BMI) (coefficient β =-0.393, p = 0.002) and with high serum resistin levels (coefficient β = 0.332, p = 0.018). According to a multiple regression analysis, the serum resistin level was a significant independent factor related to EPO resistance (p = 0.017). The results suggest that serum resistin levels reflect EPO responsiveness in nondiabetic HD patients. Resistin may therefore be considered as a new marker of EPO responsiveness in HD patients.     

Perioperative intravenous iron preserves iron stores and may hasten the recovery from post-operative anaemia after knee replacement surgery

In unilateral total knee replacement (TKR), perioperative blood loss, low transfusion thresholds and short hospital stay result in patients being discharged with low haemoglobin (Hb). We assessed the effects of perioperative administration of intravenous iron, with or without erythropoietin, plus a restrictive transfusion threshold (Hb < 80 g L(-1)) both on transfusion rate and recovery from post-operative anaemia. TRK patients received iron sucrose (2 x 200 mg per 48 h, iv) (Group IVI, n = 129). Patients with admission Hb < 130 g L(-1), also received erythropoietin (1 x 40 000 IU, sc) (Group EPO, n = 19). Perioperative clinical and laboratory data were obtained. Mean Hb loss was 36 g L(-1), but only seven patients were transfused (5%). Pre-operatively, 66 (45%) patients did not have enough stored iron to compensate Hb loss. At post-operative day 30, only 15% were anaemic, 70% of Hb loss and 92% of pre-operative Hb were recovered and ferritin increased by 73 microg L(-1) (P < 0.01), although erythropoietic response was higher in patients receiving erythropoietin (P < 0.05). No adverse effects of iron sucrose or erythropoietin were witnessed. This protocol seems to reduce allogeneic blood transfusion rate and may hasten the recovery from post-operative anaemia in TKR patients, without depleting iron stores. Further studies are needed to ascertain which patients may benefit of extended intravenous iron and/or erythropoietin administration.     

Serum erythropoietin concentrations in patients with anemia--preliminary hemoglobin-related reference ranges

Serum erythropoietin (EPO) determination is useful in the diagnosis of renal anemia. In anemic patients with normal renal function increased EPO concentrations are typically found, however, so far hemoglobin-related reference ranges for serum EPO had not been established. In a cross-sectional manner we determined serum EPO in 280 patients with anemia and normal serum concentrations of creatinine and urea. Each 70 consecutive anemic patients with hemoglobin concentrations within four intervals were included (<8 g/dL; 8.1-9.0 g/dL; 9.1-10.0 g/dL; 10.1-11.0 g/dL). 97 patients were from surgical disciplines, 183 were from internal disciplines. Serum EPO was determined by use of an automated sandwich immunoassay that is standardized according to the WHO 2nd IRP 67/343. The ranges between the 20th and 80th percentile of EPO concentrations for the four specified hemoglobin intervals were as follows: Hb <8 g/dL, EPO 61.8-366 IU/L; Hb 8.1-9.0 g/dL, EPO 43.3-242 IU/L; Hb 9.1-10.0 g/dL, EPO 31.8-113 IU/L; Hb 10.1-11.0 g/dL, EPO 22.3-71.2 IU/L. Since no complete diagnostic evaluation of the patients' renal and respiratory functions was performed in this cross-sectional study we propose the 20th percentile of EPO concentrations as a preliminary hemoglobin-related reference range; serum EPO concentrations below this percentile speak for a contribution of EPO deficiency in the individual etiology of anemia.     

Effective utilization of erythropoietin with intravenous iron therapy

Introduction: Iron replacement therapy reduces the demand for erythropoietin (EPO) in some dialysis patients. It has been postulated that iron supply to the bone marrow is a rate-limiting step in the process of erythropoiesis under erythropoietin stimulation. Methods: We evaluated the economic benefit of intravenous iron therapy for this purpose in a prospective, non-blinded study of 22 haemodialysis patients, 16 male, six female, mean age 62 years (range 24–80 years). All patients had a serum ferritin (SF) of 460 μg/L, despite oral iron therapy. Patients with high aluminium and/or parathyroid hormone (PTH) levels, underlying bleeding/haematological disorders or active inflammatory diseases were excluded. Patients were established on subcutaneous EPO and given intravenous iron over seven consecutive dialysis sessions (total dose 1050 mg) and supplemental monthly doses with regular monitoring for 4 months. Results: The median EPO dose was 4000 units/week (mean 6050 units/week) pre-treatment and 2000 units/week (mean 3700 units) at 6 weeks post intravenous iron therapy ( P=0·03). No serious adverse events occurred in the 154 treatment sessions of intravenous iron. Mean haemoglobin (Hb) level remained constant at 6 and 12 weeks ( P=0·087). Serum ferritin levels (P< 0·0001) rose significantly, while a reduction in transferrin saturation (TS) became significant at the end of the study ( P=0·0047). The use of intravenous iron allowed a substantial monthly cost saving per patient in our unit. Conclusion: Intravenous iron therapy is a safe and cost-effective method for maintaining or improving Hb levels with a more effective utilization of EPO in patients with low SF levels despite oral iron therapy.     

维持性血液透析患者贫血治疗中铁调素的变化和影响因素

目的探讨铁调素在维持性血液透析（Maintenance hemodialysis,MHD）患者贫血治疗中对铁稳态的调节作用,及与铁剂补充、红细胞生成素（erythropoietin,EPO）应用的相互影响,探求恢复机体铁稳态的治疗方法。方法选取同济大学附属东方医院肾内科血液净化中心的32例MHD患者,HD时间6月以上,血红蛋白低于110g／L,给予常规补铁及EPO治疗,应用ELISA方法测定患者血清铁调素水平,分析其与铁代谢指标血清铁,血清铁蛋白（Serum ferritin,SF）与转铁蛋白饱和度（Transferrin saturation,TSAT）以及红细胞生成、铁剂补充和EPO应用的相关性及相互作用。结果MHD患者血清铁调素水平显著高于正常对照组（324±124．2ng／L比72．4±12．3ng／L,P〈0．001）,相关性分析显示铁调素与血清铁、SF及TSAT正相关（r分别为0．68,0．62,0．7,P值分别为0．005,0．004,0．001）,与网织红细胞计数呈负相关（r=0．63,P=0．015）。常规血液透析可有效清除铁调素,但于2周后血液透析前血清铁调素水平几乎可恢复至原水平。在贫血治疗中,EPO应用而非静脉补铁可显著降低铁调素水平,改善贫血的同时促进了铁的利用。结论MHD患者铁调素显著升高,参与了铁代谢紊乱的发病和红细胞生成的调控;及时有效的清除铁调素和足量EPO应用可改善红细胞生成及铁的循环利用,恢复机体铁稳态,防止铁超载对机体的进一步损伤。     

静脉用蔗糖铁治疗血液透析患者肾性贫血的疗效观察及护理

目的探讨静脉补铁对肾性贫血的疗效及护理。方法 46例维持血液透析的贫血患者分为静脉和口服两组,治疗8周后观察其Hb、RBC等各项指标的变化。结果静脉组治疗前后的Hb为(70.05±16.19)g/L及(86.19±13.04)g/L,RBC为(2.51±0.56)×1012/L及(3.08±0.65)×1012/L,Hct为0.218±0.051及0.274±0.046,SF为(215.43±98.31)μg/L及(510.99±136.96)μg/L,TSAT为(21.03±5.83)%及(33.51±7.47)%,差异具有统计学意义(P均<0.01);且Hb、Hct、SF、TSAT增高幅度明显高于口服组(P<0.05)。口服组治疗前后各指标均无统计学差异。结论静脉补铁治疗血液透析患者肾性贫血疗效优于口服铁剂。     

Erythropoietin requirement in patients with type 2 diabetes mellitus on maintenance hemodialysis therapy

Diabetes is known to be a risk factor for the severity of anemia in non-dialyzed patients with renal failure. The aim of this study was to evaluate differences in hemoglobin (Hb) response to erythropoietin (EPO) in diabetic and nondiabetic patients on chronic hemodialysis (CHD). Sixty-four patients on CHD were included in the study: 24 type 2 diabetics (mean age, 59+/-11 years; 10 men, 14 women) and 40 nondiabetics (age, 53+/-14 years; 21 men, 19 women). All patients received a fixed dose of 50 mg ferric saccharate and EPO per week, dosed individually to achieve a target Hb level of 12 g/dl. Hb levels, ferritin, transferrin saturation (TSAT), EPO requirement (IU/kg/week), folic acid, vitamin B12 and C-reactive protein (CRP) were measured every two months. Additionally, the incidence of infectious diseases during the observation period of six months was evaluated, and a univariate correlation analysis of CRP and EPO requirements was performed in both groups. Patients with and without diabetes were divided into two groups each: those with normal CRP and those with elevated CRP. The EPO requirements of these groups were compared. Under identical iron substitution the mean Hb level increased more, but not significantly, in non-diabetic patients than in diabetic patients. After 6 months the mean Hb levels were 12.1+/-1.2 versus 11.5+/-1.2 g/dl (NS), although the actual EPO requirement was higher in diabetic than in non-diabetic subjects (244+/-122 versus 183+/-118 IU/kg/week; p<0.05). CRP after 6 months was significantly higher in diabetic than in non-diabetic patients (2.6+/-2.2 versus 1.5+/-1.3 mg/dl; p<0.05), as was the incidence of infectious disease (n/patient/month) (0.24 versus 0.08; p<0.05). The correlation coefficient between CRP and EPO requirements was statistically significant in both diabetic (r=0.547 p<0.01) and non-diabetic subjects (r=0.577; p<0.001). All other laboratory indices were similar in both groups. In the diabetic patients with normal CRP (n=6) the Hb levels achieved after six months were similar to those of non-diabetic patients (n=10) with normal CRP (11.9+/-1.1 versus 12.1+/-1.2%), and the required EPO was comparable. We conclude that the Hb response to EPO is reduced in diabetic patients on CHD. This elevated EPO requirement may be explained by a greater prevalence of infectious diseases, characterized by a significantly higher CRP level, in these patients. Other causes for the elevated EPO requirement could be excluded.