Beneficial influence of recombinant human erythropoietin therapy on the rate of progression of chronic renal failure in predialysis patients
Beneficial influence of recombinant human erythropoietin therapy on the rate of progression of chronic renal failure in predialysis patients
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DOI：
10.1093/ndt/16.2.307
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发表时间：
2001-02-01
影响因子：
6.1
通讯作者：
Man, NK
中科院分区：
文献类型：
--
作者：
Jungers, P;Choukroun, G;Man, NK
背景资料。重组人促红细胞生成素(RHuEPO)部分纠正贫血可显著改善透析前患者的一般状况和生活质量，但rHuEPO治疗对血压和慢性肾功能衰竭(CRF)进展速度的影响仍存在争议。特别是，与未治疗的透析前患者相比，没有研究评估接受治疗的患者开始维持透析的持续时间。我们回顾评估了20例接受rHuEPO治疗的晚期CRF患者(EPO+组)和43例CRF患者(EPO-组)的肌酐清除率下降率(Delta Ccr)和透析前持续时间。所有患者都接受了相同的临床和实验室监测。所有人都接受了类似的BG口服补充。B-9、B-12维生素和口服铁质补充剂。皮下注射促红细胞生成素维持剂量为54.3+/-16.5U/kg/周，中位剂量为3300U/周。EPO+组的初始和最终血红蛋白水平分别为8.8+/-0.7和11.3+/-0.9g/dl，EPO-组分别为10.9+/-1.2和9.5+/-0.9g/dl。在EPO+组，Delta Ccr从24个月前的0.36+/-0.16下降到rHuEPO治疗后的0.26+/-0.15 ml/min/1.73 m(2)/月(P<；0.05)。EPO组未观察到明显变化。EPO+组开始透析的时间为16.2±11.9个月，EPO-组为10.6+/-6.1个月(P<；0.01)。10例EPO+患者的CRF进展明显减慢，而其余10例患者的Ccr无明显变化。两组患者在接受rHuEPO治疗时，既往Delta Ccr晚期、Hb和血压水平均无明显差异。结论本研究提供了确凿的证据，表明rHuEPO治疗不会导致任何治疗的透析前患者CRF进展加快，也不会导致血压的有害升高，反而会显著减缓CRF的进展，并显著延缓维持性透析的进行。这种令人鼓舞的结果仍有待于一项大型前瞻性随机研究的验证。
Background. Partial correction of anaemia with recombinant human erythropoietin (rHuEpo) has been shown to markedly improve the general condition and quality of life of predialysis patients, but the effects of rHuEpo therapy on blood pressure and the rate of progression of chronic renal failure (CRF) are still disputed. In particular, no study evaluated the time duration until the start of maintenance dialysis in treated patients, compared to untreated predialysis patients.Methods. We retrospectively evaluated the rate of decline of creatinine clearance (Delta Ccr) and the duration of the predialysis period in 20 patients with advanced CRF treated with rHuEpo (Epo+ group), and in 43 patients with a similar degree of CRF but with less marked, asymptomatic anaemia, not requiring rHuEpo therapy (Epo- group). All patients were submitted to identical clinical and laboratory surveillance. All received similar oral supplementation with Bg. B-9, and B-12 vitamins and oral iron supplementation. Maintenance dose of subcutaneous epoetin was 54.3 +/- 16.5 U/kg/week (median dose 3300 U/week).Results. Initial and final haemoglobin (Hb) levels were 8.8 +/- 0.7 and 11.3 +/- 0.9 g/dl in the Epo+ group, vs 10.9 +/- 1.2 and 9.5 +/- 0.9 g/dl in the Epo- group. In the Epo+ group, Delta Ccr declined from 0.36 +/- 0.16 during the preceding 24 months to 0.26 +/- 0.15 ml/min/1.73 m(2)/month after the start of rHuEpo therapy (P < 0.05). No significant variation was observed in the Epo- group. Time duration until the start of dialysis was 16.2 11.9 in the Epo + group, compared to 10.6 +/- 6.1 months in the Epo- group (P < 0.01). Slowing of progression was observed in 10 Epo+ patients, whereas no significant variation in Ccr occurred in the other 10. There was no difference in previous Delta Ccr late, nor in Hb or blood pressure levels while on rHuEpo therapy between the two subgroups.Conclusions, Our study affords conclusive evidence that rHuEpo therapy did not result in accelerated progression of CRF in any treated predialysis patients, nor deleterious increase in blood pressure, but instead resulted in significant slowing of progression and substantial retardation of maintenance dialysis. Such encouraging results remain to be validated in a large prospective, randomized study.