Iron, Inflammation, Dialysis Adequacy, Nutritional Status, and Hyperparathyroidism Modify Erythropoietic Response
Iron, Inflammation, Dialysis Adequacy, Nutritional Status, and Hyperparathyroidism Modify Erythropoietic Response
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DOI：
10.2215/cjn.04710709
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发表时间：
2010-04-01
影响因子：
9.8
通讯作者：
Aronoff, George R.
中科院分区：
文献类型：
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作者：
Gaweda, Adam E.;Goldsmith, Linda J.;Aronoff, George R.
背景和目的：血液透析患者的红细胞生成反应取决于多种生理因素。大多数流行病学研究通过将这些因素表示为混杂因素来包括这些因素的影响。这项研究测试了假设，即铁储存，炎症，透析充分性，营养状况和甲状旁腺功能亢进症作为红细胞生成反应的非线性效应调节剂，并在临床相关范围内量化这些效应的大小。设计，设置，参与者和测量：以下回顾性数据收集自209名接受Epo alfa（Epo）的血液透析患者：每月：透析前血红蛋白（Hgb）、转铁蛋白饱和度、血清白蛋白、透析充分性（Kt/V）;每季度：透析前血清铁蛋白和全段甲状旁腺激素，为期13至69个月。研究分析了血红蛋白和Epo之间的动态关系，考虑了铁蛋白、转铁蛋白饱和度、Kt/V、白蛋白和甲状旁腺激素对Epo的非线性影响。结果：当血清铁蛋白在350 ~ 500 ng/ml之间，转铁蛋白饱和度大于30%，Kt/V大于1.4，白蛋白大于3.8 g/dl时，血红蛋白对Epo的反应最大。血红蛋白的敏感性下降约30%，Epo甲状旁腺激素从0增加到1000 pg/ml。结论：血清铁蛋白，转铁蛋白饱和度，Kt/V，血清白蛋白，和全段甲状旁腺激素是血液透析患者红细胞生成反应的非线性效应修饰的标志物。Clin J Am Soc肾病学5：576-581，（C）2010。doi：10.2215/CJN.04710709
Background and objectives: The erythropoietic response in hemodialysis patients depends on several physiologic factors. Most epidemiologic studies include the effect of these factors by representing them as confounders. This study tested the hypothesis that iron stores, inflammation, dialysis adequacy, nutritional status, and hyperparathyroidism act as nonlinear effect modifiers of the erythropoietic response and quantified the magnitude of those effects over clinically relevant ranges.Design, setting, participants, & measurements: The following retrospective data from 209 hemodialysis patients receiving Epoetin alfa (Epo) were collected: monthly: predialysis hemoglobin (Hgb), transferrin saturation, serum albumin, dialysis adequacy (Kt/V); quarterly: predialysis serum ferritin and intact parathyroid hormone over a period of 13 to 69 months. The study analyzed the dynamic relationship between hemoglobin and Epo, considering nonlinear effect modification by ferritin, transferrin saturation, Kt/V, albumin, and parathyroid hormone individually.Results: Maximum Hgb response to Epo was achieved for serum ferritin between 350 and 500 ng/ml, transferrin saturation greater than 30%, Kt/V greater than 1.4, and albumin greater than 3.8 g/dl. Hgb sensitivity to Epo decreases by about 30% as parathyroid hormone increases from 0 through 1000 pg/ml.Conclusions: Serum ferritin, transferrin saturation, Kt/V, serum albumin, and intact parathyroid hormone are markers of nonlinear effect modification of the erythropoietic response in hemodialysis patients. Clin J Am Soc Nephrol 5: 576-581, (C) 2010. doi: 10.2215/CJN.04710709