Hyporesponsiveness to erythropoiesis-stimulating agent as a prognostic factor in Japanese hemodialysis patients: the Q-Cohort study
Hyporesponsiveness to erythropoiesis-stimulating agent as a prognostic factor in Japanese hemodialysis patients: the Q-Cohort study
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DOI：
10.1007/s40620-014-0121-9
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发表时间：
2015-04-01
影响因子：
3.4
通讯作者：
Kitazono, Takanari
中科院分区：
文献类型：
--
作者：
Eriguchi, Rieko;Taniguchi, Masatomo;Kitazono, Takanari
以往的流行病学证据表明，红细胞生成刺激剂（ESA）的反应性与血液透析（HD）患者的预后有关。我们研究了ESA低反应性对日本HD患者死亡率和心血管事件的影响，并考虑了修正因素。共有2，905例日本HD患者接受了ESA治疗，年龄为18岁，前瞻性随访4年。使用促红细胞生成素抵抗指数（ERI）评估对ESA的反应，ERI定义为每周促红细胞生成素剂量除以HD后体重和血红蛋白值（U/kg/周/g/dl）。根据ERI水平的三分位数将患者分为三组：低ERI，千分之一货币符号5.10;中等ERI，5.11-9.43;高ERI，千分之一日元9.44。风险评估采用考克斯比例风险模型计算，调整潜在的混杂因素。4年生存率随ERI水平升高而线性下降，低、中和高ERI组分别为87.5%、82.9%和72.0%（趋势p < 0.001）。与低ERI组相比，高ERI组的多变量调整风险比（mHR）显着更高[mHR，1.64（95%置信区间，1.27-2.11）]。在高ERI组中，Kt/Va千分之1.57的患者与Kt/Va千分之1.56的患者相比，任何原因导致的死亡风险均显著降低[mHR，0.73（0.54-0.98）]。我们的研究结果表明，ESA反应性可被视为日本HD患者的重要预后因素。
Previous epidemiological evidence has suggested that responsiveness to erythropoiesis-stimulating agents (ESAs) is related to prognosis in hemodialysis (HD) patients. We investigated the effects of hyporesponsiveness to ESA on mortality and cardiovascular events in Japanese HD patients, taking modifying factors into account.A total of 2,905 Japanese HD patients aged a parts per thousand yen18 years who received ESA treatment were prospectively followed up for 4 years. Responsiveness to ESA was estimated using an erythropoietin resistance index (ERI), defined as erythropoietin dosage per week divided by post-HD weight and hemoglobin value (U/kg/week/g/dl). Patients were divided into three groups by tertiles of ERI levels: low ERI, a parts per thousand currency sign5.10; intermediate ERI, 5.11-9.43; high ERI, a parts per thousand yen9.44. Risk estimates were calculated by a Cox proportional hazards model, adjusting for potential confounders.During follow-up, 482 patients died from any causes. The 4-year survival rate decreased linearly with higher ERI levels, being 87.5, 82.9, and 72.0 % for low, intermediate, and high ERI group (p for trend < 0.001). Compared with the low ERI group, the multivariate-adjusted hazard ratio (mHR) was significantly higher in the high ERI group [mHR, 1.64 (95 % confidence interval, 1.27-2.11)]. In the high ERI group, patients with Kt/V a parts per thousand yen 1.57 had a significantly lower risk of death from any causes compared with those with Kt/V a parts per thousand currency sign 1.56 [mHR, 0.73 (0.54-0.98)].Our findings suggest that ESA responsiveness can be considered a significant prognostic factor in Japanese HD patients.