血红蛋白变异性对初始血液透析患者残余肾功能的影响

Effect of hemoglobin variability on residual renal function in patients on initial hemodialysis

目的探讨血红蛋白变异性对初始血液透析(简称血透)患者残余肾功能(RRF)的影响,并探讨低氧诱导因子脯氨酰羟化酶抑制剂(HIF-PHI)和重组人促红素注射液(EPO)对二者的影响。方法回顾性分析2020年1月至2021年1月于大连瑞凯尔肾病医院行初始血透且患有肾性贫血的70例患者的临床资料。收集患者基线和随访12个月时的化验检查结果,检测尿尿素及血清尿素浓度计算RRF。每3个月复查血红蛋白(Hb)水平,以Hb的残余标准差(Res-SD)代表血红蛋白变异性。按12个月RRF下降中位数分为RRF下降慢组[<1.60 mL/(min·1.73 m^(2))](35例)和RRF下降快组[≥1.60 mL/(min·1.73 m^(2))](35例);按治疗肾性贫血的药物分为HIF-PHI组(24例)和EPO组(46例)。比较RRF下降快组与下降慢组患者临床资料的差异及治疗药物对血红蛋白变异性的影响,多因素logistic回归分析RRF下降的影响因素。结果随访12个月,RRF下降慢组的Hb Res-SD显著低于RRF下降快组,差异有统计学意义[(3.87±1.48)g/L比(4.75±1.45)g/L,P<0.05)]。与RRF下降快组相比,RRF下降慢组白蛋白、单室尿素清除指数(spKT/V)水平均显著升高,C反应蛋白显著降低,差异有统计学意义(P<0.05)。HIF-PHI组和EPO组随访12个月时RRF下降和Hb Res-SD差异均无统计学意义(P>0.05)。多因素logistic回归分析提示Hb Res-SD≥4.29 g/L是RRF降低的危险因素(OR 5.46,95%CI 1.16~25.79,P<0.05);spKT/V≥1.2是RRF降低的保护因素(OR 0.11,95%CI 0.01~0.87,P<0.05)。结论初始血透患者第1年RRF降低与血红蛋白变异性有关,HIF-PHI和EPO对血红蛋白变异性无影响。

Objective To investigate the effect of hemoglobin variability on residual renal function(RRF)in initial hemodialysis patients and explore the effects of hypoxia-inducible factor prolyl hydroxylase inhibitor(HIF-PHI)and recombinant human erythropoietin injection(EPO)on them.Methods The clinical data of 70 patients with renal anemia who started hemodialysis in Dalian Renal Care Hospital from January 2020 to January 2021 were retrospectively analyzed.Laboratory results were collected at baseline and 12 months of follow-up,and urinary and serum urea data were collected to calculate RRF according to the formula.Hemoglobin(Hb)was rechecked every 3 months,and residual standard deviation(Res-SD)of Hb was used to represent hemoglobin variability.According to the median decline of RRF in 12 months,patients were divided into two groups:slow decline group of RRF[<1.60 mL/(min·1.73 m^(2))](n=35)and fast decline group of RRF[≥1.60 mL/(min·1.73 m^(2))](n=35).According to the drugs used to treat renal anemia,patients were divided into HIF-PHI group(n=24)and EPO group(n=46).The difference in clinical data between the fast RRF decline group and the slow RRF decline group and the influence of therapeutic drugs on hemoglobin variability were compared,respectively.Multivariate logistic regression analysis was used to analyze influencing factors of RRF decline.Results During a follow-up of 12 months,the Hb Res-SD of slow RRF group was significantly lower than that of fast RRF decline group with statistical significance[(3.87±1.48)vs.(4.75±1.45)g/L,P<0.05].Compared with the fast RRF decline group,the levels of albumin and single-compartment urea clearance index(spKT/V)sinificantly increased in the slow RRF decline group,while the C-reactive protein significantly decreased with statistical significance(P<0.05).There was no statistical difference in the annual RRF decrease and Hb ResSD between the HIF-PHI group and the EPO group(P>0.05).Multivariate logistic regression analysis showed that Hb ResSD≥4.29 g/L was a risk factor for RRF decline(OR 5.46,95%CI 1.16-25.79,P<0.05),and Kt/V≥1.2 was a protective factor for RRF decline(OR 0.11,95%CI 0.01-0.87,P<0.05).Conclusion The decline of residual renal function in the first year of initial hemodialysis patients was associated with their hemoglobin variabilities,while there was no difference between HIF-PHI and EPO effects on hemoglobin variabilities.