Associations between changes in hemoglobin and administered erythropoiesis-stimulating agent and survival in hemodialysis patients
Associations between changes in hemoglobin and administered erythropoiesis-stimulating agent and survival in hemodialysis patients
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DOI：
10.1681/asn.2005090997
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发表时间：
2006-04-01
影响因子：
13.6
通讯作者：
Kalantar-Zadeh, Kamyar
中科院分区：
文献类型：
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作者：
Regidor, Deborah L.;Kopple, Joel D.;Kalantar-Zadeh, Kamyar
虽然通过红细胞生成刺激剂（ESA）治疗慢性肾病贫血可能会改善生存率，但大多数研究都检查了基线血红蛋白值与生存率之间的相关性，忽略了临床和实验室的变化。随着时间的推移。目前尚不清楚血红蛋白或ESA的纵向变化是否与调整后随时间变化的混杂因素的生存有意义的关联。使用时间依赖性考克斯回归模型，在美国一家大型透析组织（DaVita）的58,058例维持性血液透析患者的2年（2001年7月至2003年6月）队列中，研究了生存率与季度（13周平均）血红蛋白值和ESA给药剂量之间的纵向关联。在对病例组合进行时间依赖性和多变量调整后，每季度改变静脉铁剂和ESA剂量、铁标记物和营养状况，血红蛋白水平在12和13 g/dl之间与最高生存率相关。在患病患者中，推荐的肾脏疾病质量结局倡议血红蛋白目标范围较低（11至11.5 g/dl）与11.5至12 g/dl范围相比，死亡风险较高。血红蛋白随时间的减少或增加分别与较高或较低的死亡风险相关，与基线血红蛋白无关。给予任何剂量的ESA都与更好的生存率相关，而在接受ESA的患者中，需要更高剂量的ESA是更高死亡风险的替代品。在这项观察性研究中，更高的生存率与基线血红蛋白12 - 13 g/dl、ESA治疗和血红蛋白升高相关。血红蛋白下降和需要更高的ESA剂量与生存率下降相关。需要进行随机临床试验来检查这些关联。
Although treating anemia of chronic kidney disease by erythropoiesis-stimulating agents (ESA) may improve survival, most studies have examined associations between baseline hemoglobin values and survival and ignored variations in clinical and laboratory. measures over time. It is not clear whether longitudinal changes in hemoglobin or administered ESA have meaningful associations with survival after adjustment for time-varying confounders. With the use of time-dependent Cox regression models, longitudinal associations were examined between survival and quarterly (13-wk averaged) hemoglobin values and administered ESA dose in a 2-yr (July 2001 to June 2003) cohort of 58,058 maintenance hemodialysis patients from a large dialysis organization (DaVita) in the United States. After time-dependent and multivariate adjustment for case mix, quarterly varying administered intravenous iron and ESA doses, iron markers, and nutritional status, hemoglobin levels between 12 and 13 g/dl were associated with the greatest survival. Among prevalent patients, the lower range of the recommended Kidney Disease Quality Outcomes Initiative hemoglobin target (11 to 11.5 g/dl) was associated with a higher death risk compared with the 11.5- to 12-g/dl range. A decrease or increase in hemoglobin over time was associated with higher or lower death risk, respectively, independent of baseline hemoglobin. Administration of any dose of ESA was associated with better survival, whereas among those who received ESA, requiring higher doses were surrogates of higher death risk. In this observational study, greater survival was associated with a baseline hemoglobin between 12 and 13 g/dl, treatment with ESA, and rising hemoglobin. Falling hemoglobin and requiring higher ESA doses were associated with decreased survival. Randomized clinical trials are required to examine these associations.