Serum erythropoietin concentrations and responses to anaemia in patients with or without chronic kidney disease
Serum erythropoietin concentrations and responses to anaemia in patients with or without chronic kidney disease
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DOI：
10.1093/ndt/gfm316
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发表时间：
2007-10-01
影响因子：
6.1
通讯作者：
Risler, Teut
中科院分区：
文献类型：
--
作者：
Artunc, Ferruh;Risler, Teut
背景肾性贫血是由红细胞生成素（EPO）相对缺乏引起的。由于难以解释血清EPO浓度适用于贫血和肾功能，测量血清EPO浓度的诊断价值是有限的。我们回顾性分析了血红蛋白和血清EPO浓度之间的关系，从2001年至2004年在我们大学医院的门诊和住院患者常规测量。排除EPO替代或急性肾衰竭、多囊肾、肾癌或肺部疾病引起的红细胞增多症患者。研究人群（n = 500）根据是否存在慢性肾脏疾病（CKD）以及如果存在CKD的分期进行分层。EPO浓度以贫血严重程度校正的单位表示，并基于无CKD患者的EPO反应。在无CKD的患者（n 167）中，贫血严重程度与EPO升高之间存在强参数相关性（r = -0.81）。对数转换的EPO值的线性回归显示方程log EPO（mIU/ml）= -0.135 x Hb（g/dl）+2.821（r（2）= 0.65）。随着CKD分期的增加，血红蛋白和EPO浓度之间的相关性逐渐减弱，并在CKD 4期和5期完全消失。在Hb < 11 g/dl的贫血患者中，相对EPO缺乏定义为EPO浓度低于第25百分位数，分别出现在38%、67%、93%和100%的CKD 1 - 5期患者中。EPO浓度在肾脏中的表达提高了测量EPO浓度用于诊断相对EPO缺乏和肾性贫血的诊断价值。
Background. Renal anaemia is caused by a relative erythropoietin (EPO) deficiency. Due to difficult interpretation of serum EPO concentrations adapted to anaemia and renal function, the diagnostic value of measuring serum EPO concentrations is limited.Methods. We retrospectively analysed the relationship between haemoglobin and serum EPO concentrations routinely measured in in- and out-patients of our university hospital from 2001 - 04. Patients under EPO substitution or those with acute renal failure, polycystic kidney disease, renal carcinoma or polycythaemia due to pulmonary disease were excluded. The study population (n = 500) was then stratified according to the presence or absence of chronic kidney disease (CKD) and to the stage if CKD was present. EPO concentrations were expressed in percentiles corrected for the severity of anaemia and based on the EPO response in patients without CKD.Results. In patients without CKD ( n 167) there was a strong parametric correlation between severity of anaemia and increase in EPO (r = -0.81). Linear regression of the log-transformed EPO values revealed the equation log EPO (mIU/ml) = -0.135 x Hb (g/dl) + 2.821 (r(2) = 0.65). With increasing stages of CKD the correlation between haemoglobin and EPO concentrations was gradually attenuated and was completely lost in CKD stage four and five. In anaemic patients with Hb < 11 g/dl, relative EPO deficiency defined as EPO concentrations below the 25th percentile was present in 38%, 67%, 93% and 100% of the patients with CKD stages 1 - 5, respectively.Conclusions. Expression of EPO concentrations in percentiles improves the diagnostic value of measuring EPO concentrations for diagnosing relative EPO deficiency and renal anaemia.