Butyrylcholinesterase level as an independent factor of erythropoiesis-stimulating agent resistance in patients on maintenance hemodialysis: a single-center cross-sectional study
Butyrylcholinesterase level as an independent factor of erythropoiesis-stimulating agent resistance in patients on maintenance hemodialysis: a single-center cross-sectional study
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丁酰胆碱酯酶水平作为维持性血液透析患者促红细胞生成剂抵抗的独立因素：一项单中心横断面研究
DOI：
10.1007/s10157-018-1569-z
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发表时间：
2018
影响因子：
2.3
通讯作者：
Ohyama Chikara
中科院分区：
文献类型：
--
作者：
Okamoto Teppei;Hatakeyama Shingo;Tanaka Yoshimi;Imanishi Kengo;Takashima Tooru;Saitoh Fumitada;Koie Takuya;Suzuki Tadashi;Ohyama Chikara
背景：促红细胞生成素（ESA）反应性与血液透析（HD）患者的营养状况有关。血清丁基胆碱酯酶（BChE），一种α糖蛋白，可能在营养不良的情况下下降。我们调查了BChE是否与HD患者的ESA耐药独立相关。方法对2017年7月至9月215例HD患者的实验室数据和ESA耐药指数（ERI）进行研究，ERI定义为每周ESA剂量除以干重和血红蛋白。营养不良定义为老年人营养风险指数(GNRI) < 91.2。将患者分为ERI高（ERI≥9.44）组和ERI低（ERI < 9.44）组。比较两组患者的背景、用药和实验室数据等变量。利用受者工作特性分析确定了较高ERI时BChE的最佳截止值。使用多变量逻辑回归分析确定与较高ERI独立相关的因素。结果ERI和BChE的中值和最佳临界值分别为6.51和200 IU/L。该研究分别纳入了71例（33%）和144例（67%）eri高组和低组患者。在年龄、血红蛋白、ESA剂量、脂质谱、血清白蛋白、体重指数、GNRI、铁代谢标志物、铁药物和BChE方面，组间存在显著差异。多因素分析显示，在调整潜在混杂因素后，BChE < 200 IU/L（比值比3.67；95%置信区间1.73-7.77）仍然是与较高ERI相关的独立因素，其比值比与GNRI < 91.2相似。结论bche可作为ESA耐药的独立指标。
BackgroundErythropoiesis-stimulating agent (ESA) responsiveness is related to the nutritional status of patients on hemodialysis (HD). Serum butyrylcholinesterase (BChE), an alpha-glycoprotein, may decrease in case of malnutrition. We investigated whether BChE was independently related to ESA resistance in patients on HD.MethodsThe laboratory data and ESA resistance index (ERI), defined as ESA dosage per week divided by dry weight and hemoglobin, were investigated in 215 patients on HD between July and September 2017. Malnutrition was defined as Geriatric Nutritional Risk Index (GNRI) of < 91.2. The patients were stratified into two groups: ERI-high (ERI ≥ 9.44) and ERI-low (ERI < 9.44) groups. Variables such as patient’s background, medication, and laboratory data were compared between the two groups. The optimal cutoff value of BChE for higher ERI was determined using receiver operating characteristic analysis. Factors independently associated with higher ERI were determined using multivariate logistic regression analysis.ResultsThe median and optimal cutoff values of ERI and BChE were 6.51 and 200 IU/L, respectively. The study included 71 (33%) and 144 (67%) patients in the ERI-high and ERI-low groups, respectively. Significant between-group differences were observed concerning age, hemoglobin, ESA dose, lipid profiles, serum albumin, body mass index, GNRI, iron metabolism markers, ferric medicines, and BChE. Multivariate analysis showed that BChE < 200 IU/L (odds ratio 3.67; 95% confidence interval 1.73–7.77) continued to be an independent factor associated with higher ERI after adjusting for potential confounders, which was a similar odds ratio as GNRI < 91.2.ConclusionBChE may be an independent indicator of ESA resistance.