糖尿病肾病所致终末期肾脏病维持性血液透析患者贫血的多中心临床研究

A multicenter clinical study of anemia in maintenance hemodialysis patients with end stage renal disease due to diabetic nephropathy

目的调查糖尿病肾病(diabetic nephropathy,DN)所致终末期肾脏病维持性血液透析患者的贫血情况,从而为临床上制订更好的DN治疗策略提供依据。方法收集上海市39家血液透析中心因糖尿病肾病所致终末期肾脏病维持性血液透析的558例患者的贫血相关的临床和实验室检查资料,并进行相关分析。结果 558例患者中贫血患病率为90.1%,男女患者贫血的患病率无显著性差异(P=0.639);各年龄段糖尿病肾病患者的血红蛋白有显著性差异(P=0.001),各年龄组患者发生贫血率呈上升趋势(P=0.003);红细胞生成素(EPO)治疗率为85.1%,使用EPO平均剂量为139.50士59.12(17.76～430.11)u/(Kg·W);轻、中、重度贫血组EPO应用率无显著性差异(P=0.149);各个不同贫血程度组EPO使用剂量之间有差别(P=0.006),重度贫血组剂量最高,轻度贫血组剂量最低。结论糖尿病肾病所致终末期肾脏病维持性血液透析患者普遍存在贫血,其贫血的治疗率较高,但达标率低。

Objective This study investigated the prevalence and treatment of anemia in maintenance hemodialysis （MHD） patients due to diabetic nephropathy （DN）, in order to upgrade the treatment for DN. Methods A total of 558 patients with diabetic kidney disease treated in the period from Mar. 2011 to Mar. 2012 in the 39 hemodialysis centers in Shanghai were enrolled. Data were statistically analyzed using SPSS 19.0 for Windows. Results The prevalence of anemia was 90.1% in the 558 patients and was indifferent between men and women （P=0.639）. Hemoglobin （Hb） was significant different among different age groups （P= 0.001） and anemia prevalence increased with age （P=0.003）. Erythropoietin （EPO） was given in 85.1% patients, and the average EPO dosage was 139.5＋59.1 （17.8 ±430.1） U/（kg · week）. The percentage of EPO administration was similar （P=0.149）, but the dosage was different （P=0.006） among severe, moderate and mild anemia patients. EPO dosage was the highest in severe anemia patients and was the lowest in mild anemia patients. Conclusions The prevalefice of anemia was higher in MHD patients with DN. EPO was given to most anemic MHD patients with DN, but only a few patients obtained the target Hb level.