腹膜透析患者残余肾功能对罗沙司他疗效的影响

Effect of residual renal function on the efficacy of roxadustat in peritoneal dialysis patients

目的研究维持性腹膜透析(PD)患者的残余肾功能(RRF)对罗沙司他治疗效果的影响。方法选取2019年12月至2020年12月本院应用罗沙司他治疗肾性贫血的146例维持性PD患者,分为无RRF组[RRF<2 mL·(min·1.73 m^(2))^(-1),75例]和有RRF组[RRF≥2 mL·(min·1.73 m^(2))^(-1),71例]。比较两组患者治疗12周后的血红蛋白(Hb)、高敏C-反应蛋白(hs-CRP)、白蛋白、转铁蛋白饱和度(TS)、铁蛋白以及Hb达标率。采用logistic回归分析Hb达标率的影响因素,采用受试者工作特征(ROC)曲线分析RRF预测罗沙司他治疗后Hb达标率的价值。结果治疗12周后,两组患者的Hb均较治疗前明显升高(均P<0.001)。有RRF组患者治疗后的Hb和Hb达标率均高于无RRF组(119.99 g/L vs.100.31 g/L、74.6%vs.21.3%,均P<0.001)。两组患者的hs-CRP、白蛋白、TS、铁蛋白指标比较,差异均无统计学意义(均P>0.05)。单因素logistic回归分析结果表明:RRF、尿量、治疗前Hb与罗沙司他治疗后的Hb达标率均有相关性(均P<0.05);多因素logistic回归分析结果表明:RRF(OR=3.169,95%CI:2.098~4.787)、治疗前Hb(OR=1.061,95%CI:1.027~1.096)是罗沙司他治疗后Hb达标率的独立影响因素(均P<0.001)。ROC曲线分析结果表明:RRF预测Hb达标率的曲线下面积是0.861,截点值为2 mL·(min·1.73 m^(2))^(-1)时,灵敏度为0.768,特异度为0.766。结论保护RRF和尿量有利于维持性PD患者应用罗沙司他后Hb达标。PD患者应用罗沙司他治疗早期需加强监测Hb,尤其是保留RRF患者,及时调整罗沙司他的治疗方案,合理控制肾性贫血。

Objective To study the effect of residual renal function(RRF)on the efficacy of roxadustat in peritoneal dialysis patients.Methods A total of 146 maintenance peritoneal dialysis patients with renal anemia treated with rosalrestat in our hospital from December 2019 to December 2020 were selected and divided into RRF-free group[RRF<2 mL·(min·1.73 m^(2))^(-1),75 cases]and RRF group[RRF≥2 mL·(min·1.73 m^(2))^(-1),71 cases].The index of hemoglobin(Hb),high sensitivity C-reactive protein(hs-CRP),albumin,transferrin saturation(TS),ferritin after 12 weeks of treatment and the Hb compliance rate were compared between the two groups.Logistic regression analysis was used to analyze the influencing factors of the Hb compliance rate after treatment.ROC curve was used to analyze the value of RRF in predicting the standard rate of Hb after treatment.Results After 12 weeks of treatment,Hb in both groups was significantly higher than that before treatment(all P<0.001).After treatment,the Hb and Hb compliance rate of patients with RRF were higher than those RRF-free group(119.99 g/L vs.100.31 g/L,74.6%vs.21.3%,all P<0.001).There were no significant differences in hs-CRP,albumin,TS and ferritin indexes between 2 groups(all P>0.05).Univariate logistic regression analysis showed that RRF,urine volume and Hb before treatment were correlated with the Hb compliance rate after rosalrestat treatment(all P<0.05).Multivariate logistic regression analysis showed that RRF(OR=3.169,95%CI:2.098-4.787)and Hb before treatment(OR=1.061,95%CI:1.027-1.096)were independent influencing factors of Hb compliance rate after rosallistat treatment(all P<0.001).ROC curve analysis showed that the area under the curve of RRF to predict the standard rate of Hb was 0.861,and when the cut-off value was 2 mL·(min·1.73 m^(2))^(-1),the sensitivity was 0.768 and the specificity was 0.766.Conclusions Protection of residual renal function and urine volume is conducive to hemoglobin attainment in maintenance peritoneal dialysis patients treated with rosallistat.At the same time,peritoneal dialysis patients with rosalrestat should strengthen the monitoring of Hb at the early stage,especially patients with residual renal function,timely adjust the treatment of rosalrestat,and reasonable control of renal anemia.