혈액투석 환자의 빈혈관리에서 Erythropoietin 반응에 영향을 미치는 인자


Determinants of Erythropoietin Hyporesponsiveness in Management of Anemia in Hemodialysis Patients

신승희, 이영숙

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Objective: Although recombinant human erythropoietin (rhEPO) has revolutionized the treatment of anemia in chronic kidney disease (CKD) receiving hemodialysis (HD) with no need of blood transfusion, some patients have a blunted or appear to be resistant to rhEPO. There is a controversy in the causes of rhEPO resistance in maintenance HD patients with anemia. This study is to examine current anemia treatment outcomes and the factors influencing the rhEPO responsiveness in HD patient with CKD.
Methods: The clinical parameters or factors relating to erythrompoietin treatment outcomes and erythropoietin responsiveness were collected from the HD patients in two large dialysis centers for three months. The collected paramenters included serum iron, total iron biding capacity (TIBC), transferrin saturation rate, ferritin, albumin, intact PTH, C-reactive protein (CRP), nPCR and medications such as an angiotensin converting enzyme inhbitor, an angiotension II receptor blocker and an HMG-CoA reductase inhibitor (HMG-CoA RI). The data were analyzed to examine the degree of acheiveing the anemia treatment goal and factors relating to ERI.
Results: Among total 111 patients, 42 (42.3%) and 47 (37.8%) patients achieved the target Hct and Hb based on the Health Insurance Review and Assessment Services (HIRA) reimbursement criteria. In the higher ERI group (upper quartile), the patients had higher CRP levels (0.5 mg/dl) (p=0.0096), and lower TIBC score (<240 μg/dl) (p=0.0027), and less patients were taking HMG-CoA RI (p=0.0019). Male patients (p=0.0204), patients with high TIBC score (R2=0.084, p=0.0021) and patients taking HMG-CoA RI (p=0.0052) required to administer less dose of rhEPO meaning higher erythropoietin responsiveness.
Conclusion: Less than 50% of CKD patients were achieving the goals of anemia by erythropoietin administration in large hospitals in Korea even though the goals were lower than those of NKF-K/DOQI practice guideline. The factors influencing ERI were sex, TIBC and HMG-CoA RI administration status, and neither an ACEI nor an ARB did not influence ERI.


 연구방법 및 내용
  대상 환자
  치료 방법
  임상검사 정보자료
  치료 목표치 달성도
  저ERI와 고ERI군 간의 임상적 특징 비교
  ERI에 영향을 미치는 인자 분석
  통계 분석
 연구 결과
  환자의 특성
  치료 목표치 달성도
  저ERI군과 고ERI군 간의 임상적 특징 비교
  각종 임상적 지표들과 ERI와의 관계
 고찰 및 결론


  • 신승희 Seung-hee Shin. 숙명여자대학교 임상약학대학원
  • 이영숙 Young Sook Lee. 원광대학교 약학대학


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