Erythropoietin therapy for treating anaemia among haemodialysis patients: associations with survival and comparison of treatment strategies

患有肾脏疾病的人通常会贫血，这会降低他们的生活质量，症状包括疲劳、头晕和呼吸短促。贫血是循环红细胞的质量和/或数量低于正常的一种状态。肾脏产生一种叫做促红细胞生成素（EPO）的物质，它刺激骨髓产生红细胞。促生成素的丧失是肾衰竭中贫血的主要原因。贫血是通过血液血红蛋白水平来测量的，可以通过注射药物形式的促红细胞生成素来治疗。然而，目前我们对大剂量促生成素的安全性了解还不够。这项研究的目的是确定EPO治疗慢性肾病患者血液透析的最佳用途，如果肾脏衰竭，这种治疗可以接管肾脏的工作。英国肾脏登记处收集了英国所有中心接受肾脏替代治疗的成年人的数据，并将提供接受血液透析的患者的数据。将从数据库中提取相关患者信息，包括年龄、性别、疾病信息、血液检查结果、促生成素剂量和治疗日期等数据。我将观察英国患者血红蛋白水平和EPO剂量随时间的变化，并将趋势与英国治疗指南的变化进行比较。我将观察人与人之间血红蛋白水平的差异，并检查个别患者体内重复血红蛋白水平的模式。我将调查有多少人对促生成素治疗产生耐药性。EPO耐药是指尽管EPO剂量高于正常水平，但仍未能达到血红蛋白目标的患者，或持续需要更高剂量以将血红蛋白保持在特定水平的患者。我将看看哪些因素可以预测人们是否接受促生成素治疗，并检查促生成素治疗是否与患者的生存有关。最后，我将使用新颖的统计技术来研究哪种纠正贫血的策略能提供最好的生存率和最低的住院风险。研究结果将是重要的，因为它们将帮助临床医生更好地了解血液透析患者适当的EPO剂量。

People with kidney disease are often anaemic, which can reduce their quality of life, with symptoms of fatigue, dizziness, and shortness of breath. Anaemia is a state in which the quality and/or quantity of circulating red blood cells are below normal. The kidneys produce a substance called erythropoietin (EPO) which stimulates the bone marrow to produce red blood cells. Loss of EPO production is a major cause of anaemia in renal failure. Anaemia is measured by blood haemoglobin levels, and can be treated by injections of EPO in drug form. However, at present we do not know enough about the safety of high doses of EPO. This study aims to establish the best use of EPO treatment for patients with chronic kidney disease on haemodialysis, a treatment that takes over the work of the kidneys if they fail. The UK Renal Registry collects data on adults receiving renal replacement therapy from all centres across the UK, and will provide data on patients receiving haemodialysis. Relevant patient information will be extracted from the database, including data on age, sex, disease information, results from blood tests, EPO dose and treatment dates.I will look at haemoglobin levels in patients and EPO dosing over time in the UK, and will compare trends to changes in the UK treatment guidelines. I will see by how much haemoglobin levels differ between people and will examine patterns of repeated haemoglobin levels within individual patients. I will investigate how many people become resistant to EPO therapy. EPO resistance describes patients who fail to reach a haemoglobin target despite a higher than usual dose of EPO, or patients who continuously need a higher dose in order to keep their haemoglobin at a particular level. I will see which factors predict whether people get treated with EPO and examine if EPO treatment is related to the survival of patients. Finally, I will use novel statistical techniques to investigate which strategy for correcting anaemia gives the best survival and the lowest risk of hospitalisation. Findings will be important as they will help clinicians be more aware of the appropriate EPO dosage for haemodialysis patients.