Eff ects of continuous renal replacement therapy on infl ammation-related anemia, iron metabolism and prognosis in sepsis patients with acute kidney injury

BACKGROUND:This study aims to evaluate the eff ect of continuous renal replacement therapy(CRRT)on inflammation-related anemia,iron metabolism,and the prognosis in sepsis patients with acute kidney injury(AKI).METHODS:Sepsis patients with AKI were prospectively enrolled and randomized into the CRRT and control groups.The clinical and laboratory data on days 1,3 and 7 after intensive care unit(ICU)admission were collected.The serum interleukin(IL)-6,hepcidin,erythropoietin,ferritin,and soluble transferrin receptor(sTfR)were determined by enzyme-linked immunosorbent assay.The Sequential Organ Failure Assessment(SOFA)score and 28-day mortality were recorded.Data were analyzed using Pearson’s Chi-square test or Fisher’s exact test(categorical variables),and Mann-Whitney U-test or t-test(continuous variables).RESULTS:The hemoglobin and serum erythropoietin levels did not signifi cantly diff er between the CRRT and control groups though gradually decreased within the first week of ICU admission.On days 3 and 7,the serum IL-6,hepcidin,ferritin,and red blood cell distribution width significantly decreased in the CRRT group compared to the control group(all P<0.05).On day 7,the serum iron was significantly elevated in the CRRT group compared to the control group(P<0.05).However,the serum sTfR did not signifi cantly diff er between the groups over time.In addition,the SOFA scores were signifi cantly lower in the CRRT group compared to the control group on day 7.The 28-day mortality did not signifi cantly diff er between the control and CRRT groups(38.0%vs.28.2%,P=0.332).CONCLUSION:CRRT might have beneficial effects on the improvement in inflammationrelated iron metabolism and disease severity during the fi rst week of ICU admission but not anemia and 28-day mortality in sepsis patients with AKI.

Analysis of the Short-Term Curative Effect of Roxadustat in Treating Renal Anemia in Patients with Peritoneal Dialysis

Objective:To analyze the short-term curative effect of roxadustat in the treatment of renal anemia in patients with peritoneal dialysis.Methods:70 patients with peritoneal dialysis renal anemia admitted to the dialysis department of our hospital from March 2021-March 2023 were selected as research objects,divided into a research group and a reference group according to random number drawing method,with each group consisting of 35 cases.The patients in the research group were treated with roxadustat,and those in the reference group were treated with recombinant human erythropoietin.The total efficacy,anemia index,iron metabolism index,and occurrence of adverse reactions were compared between the two groups.Results:The total efficacy of the treatment received in the research group was significantly higher than that in the reference group(P<0.05).In terms of anemia indicators,there was no statistically significant difference between the hemoglobin(Hb),the red blood cell(RBC),and the hematocrit(HCT)of both groups(P>0.05)before treatment.After treatment,the anemia indicators of the patients in the research group were significantly better than those in the reference group,(P<0.05).In terms of iron metabolism,before treatment,there was no significant difference between the total iron-binding capacity(TIBC),the transferrin(TRF),the ferritin(FER),and iron(Fe)of both groups(P>0.05).After treatment,the research group’s iron metabolism indicators were significantly better than those of the reference group(P<0.05).The incidence of adverse reactions in the research group was significantly lower than that in the reference group(P<0.05).Conclusion:The short-term curative effect of roxadustat in the treatment of peritoneal dialysis patients was demonstrated through this study,making it a viable treatment option.

Anemia treatment and left ventricular hypertrophy in non-dialysis chronic kidney disease

To this day, the target hemoglobin level that minimizes cardiovascular risk in chronic kidney disease (CKD) patients remains unclear. When one examines the many randomized trials of epoetin therapy in aggregate, enhanced quality of life provides the most cogent argument for hemoglobin levels above 110 g/L. It remains unclear whether treatment of anemia improves longevity, or even a surrogate marker (such as left ventricular [LV] mass index), especially when applied at earlier phases of CKD.

Effect of Sheng Xue Ning Tablets on Renal Anemia in Patients Subject to Maintenance Hemodialysis and Safety Evaluation: A Multi-setting Prospective Randomized Study

This study compared Sheng Xue Ning(SXN)tablets with ferrous succinate(FS)tablets in terms of their efficacy for the treatment of iron-deficient renal anemia and safety in patients subject to maintenance hemodialysis(MHD).A total of 94 patients undergoing MHD were randomly assigned to an experiment group(receiving oral SXN tablcts,SXN group)and a control group(orally given FS tablets,FS group)and followed up for 12 weeks.Erythropoietin(EPO)was used in both groups.The eficacy was assessed by detecting the subsequent changes in hemoglobin(Hb),serum iron(SI),SF and transferrin saturation(TSAT).At the 12th week,Hb and TSAT levels in both groups were significantly increased compared to those in the screening period(P<0.05).However,no significant difference in Hb and TSAT was found between the two groups.The average weekly EPO dosage used was lower in SXN group than in FS group(P<0.05)at the 10th week and the 12th week.Our study showed that SXN tablets can effectively ameliorate renal anemia and keep iron metabolism stable in MHD patients,and its efficacy is virtually close to that of FS tablets.Meanwhile,SXN tablets can reduce the dosage of EPO and have a good safety profile.

Prevalence of Severe Anemia (Hb ≤ 5 g/dl) in Non-Dialyzed Chronic Renal Failure Patients in the Nephrology and Hemodialysis Department of Point G University Hospital

Introduction: Chronic renal failure (CRF) is defined as glomerular filtration rate (GFR) less than 60 ml/min/1.73m2 for at least three (3) months. Anemia is one of its most common complications. Anemia increases the risk factor for cardiovascular mortality by 18% per gram of hemoglobin loss. Objectives: To determine the prevalence and characteristics of this severe anemia, to determine the indications for transfusion, the complications related to this anemia, the evolution and the prognosis of these patients. Materials and Methods: This was a descriptive study with retrospective data collection over 18 months (January 1, 2017 to June 30, 2018) that included hospitalized CRF patients. Were included, non-dialyzed chronic renal failure patients with Hb ≤ 5 g/dl hospitalized during the said period. Not included were chronic renal failure patients with an Hb level ≥ 5 g/dl, those followed up and/or hospitalized outside the study period. Results: Among 1176 patients, 26 had severe anemia (Hb level ≤ 5 g/dl) on CRF, a prevalence of 2.21%. The mean age was 40 years ± 32.62 with extremes of 15 and 67 years. Seventeen women and 9 men. The etiology of chronic renal failure (CRF) was hypertensive vascular nephropathy in 50% of cases. CRF was end-stage in 18 patients (69.2%). The mean hemoglobin level was 4.10 g/dl ± 0.64 with extremes of 2 and 5 g/dl. The anemia was microcytic hypochromic in 50% and aregenerative (96.2%). The main symptoms were asthenia in 20 cases (76.9%), dizziness in 20 cases (76.9%), exertional dyspnea in 19 cases (73.1%). Signs of cardiac decompensation (n = 12) were jugular turgor 10 cases (38.5%), hepato-jugular reflux 06 cases (23.1%), mitral insufficiency murmur 06 cases (23.1%). The main complication was left ventricular hypertrophy 17 cases (77.3%). There was no correlation between anemia and sex (p = 0.291), age (p = 0.778), malaria (p = 0.158), etiology of CRF (p = 0.26). The evolution after treatment of anemia was favorable in 19 patients (73.1%), unfavorable in 02 patients (7.7%) and 05 deaths (19.2%). The deaths were of cardiovascular cause: left ventricular insufficiency 04 cases, stroke 01 case. Conclusion: Anemia is frequent in patients with chronic renal failure and remains an important risk factor for cardiovascular disease and poor general condition.

Pharmacodynamic study of recombinant human erythropoietin on a renal anemia model induced by gentamycin in rats

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Impact of erythropoietin therapy on cardiorenal syndrome:A systematic review with meta-analysis

BACKGROUND Heart and kidney dysfunction frequently coexist in patients with acute heart failure due to the overlap between these two organ systems.Cardiorenal syndrome(CRS)results from pathology occurring in the heart and kidneys along with the consequences of dysfunction in one organ contributing to dysfunction in the other and vice versa.AIM To evaluate the use of erythropoietin(EPO)in patients with CRS and its effects on hemoglobin(Hb),major cardiovascular(CV)events,and hospitalization rates.METHODS On February 24,2022,searches were conducted using PubMed,MEDLINE,and EMBASE,and 148 articles were identified.A total of nine studies were considered in this systematic review.We assessed the included articles based on the National Heart,Lung,and Blood Institute quality assessment tools for controlled intervention and observational cohort or cross-sectional studies.An assessment of bias risk was conducted on the chosen studies,and data relevant to our review was extracted.RESULTS The systematic review of these studies concluded that most existing literature indicates that EPO improves baseline Hb levels and decreases myocardial remodeling and left ventricular dysfunction without reducing CV mortality.In addition,the effect of EPO on the hospitalization rate of patients with CRS needs to be further studied since this relationship is unknown.Future studies,such as randomized controlled clinical trials and prospective cohort studies,should be conducted to enhance the literature on the potential of EPO therapy in patients with CRS.CONCLUSION Our systematic review suggests that EPO therapy may have a significant role in managing CRS.The review highlights the potential benefits of EPO in improving baseline Hb levels,reducing the risk of major CV events,improving cardiac remodeling,myocardial function,New York Heart Association class,and B-type natriuretic peptide levels.However,the effect of EPO treatment on hospitalization remains unclear and needs further exploration.

Roxadustat for treatment of anemia in a cancer patient with endstage renal disease:A case report

BACKGROUNDMost cancer patients are accompanied by anemia, which will be more seriouswhen combined with end-stage renal disease (ESRD). At present, cancer-relatedanemia and renal anemia treatments mainly include erythropoiesis-stimulatingagents (ESAs), iron supplementation, and blood transfusion, but their effects areoften poor with several safety concerns. We have used roxadustat to treat anemiain a cancer patient with ESRD and achieved a successful outcome for the firsttime.CASE SUMMARYA 64-year-old man was diagnosed with right renal cancer (clear cell renal cellcarcinoma). He did not receive surgery or radiotherapy before admission. He wastreated with oral soltan (sunitinib malate) on April 18, 2017. During oral chemotherapy,he had numerous complications, including anemia, hypertension,thyroid hypofunction, skin pigment loss, and renal function deterioration. At last,he progressed to ESRD and began hemodialysis treatment. We initially treated thepatient with high-dose ESAs, iron supplementation, adequate dialysis, and evenblood transfusion, but his anemia did not improve. Roxadustat is a newlydeveloped drug for renal anemia treatment, but not for cancer-related anemia, letalone to treat anemia in cancer patients with ESRD. We prescribed oral roxadustatto the patient. After a period, his hemoglobin gradually increased. He did nothave obvious discomfort symptoms, and his tumor did not progress significantly.CONCLUSIONOral roxadustat could achieve good results in treating anemia in cancer patients with ESRD.

Effect of high flux hemodialysis on renal anemia and soluble transferrin receptor in hemodialysis patients

Objective: To investigate the effect of high throughput hemodialysis on soluble transferrin receptor in hemodialysis patients and the improvement of renal anemia. Methods: 132 patients receiving maintenance hemodialysis in our hospital from July 2017 to July 2019 were selected and divided into control group and observation group according to the random number table method, with 66 cases each. The observation group was treated with high-flux hemodialysis, while the control group was treated with low-flux hemodialysis for 6 months. Compare two groups before and after treatment serum beta 2 microglobulin (beta 2 - MG), serum creatinine (Scr), blood urea nitrogen (BUN) level, anemia related index [red blood cells deposited (HCT), hemoglobin (Hb), reticulocyte percentage (Ret%)], iron metabolism index [serum ferritin (SF), transferrin saturation (TSAT)、Hepcidin(Hepc)], soluble transferrin receptor (sTfR) levels and adverse reactions. Results: the levels of 2-MG, Scr and BUN in the two groups before treatment were compared (P>0.05). After treatment, Scr and BUN levels in the two groups were significantly decreased (P<0.05), but were compared between the two groups (P>0.05). The level of 2-MG in the observation group was lower than that in the control group (P<0.05). Before treatment, sTfR, Hb, HCT level and Ret% of the two groups were compared(P>0.05). After treatment, Hb and HCT levels in the observation group were higher than those in the control group, while Ret% were lower than those in the control group, (P<0.05). Before treatment, the levels of ST、TAST、sTfR and Hepc in the two groups were compared (P>0.05). After treatment, the level of ST and TAST in the observation group was higher than that in the control group, The levels of sTfR and Hepc were lower than the control group (P<0.05). The overall incidence of adverse reactions in the observation group (8.93%) was lower than that in the control group (10.14%), with no significant difference (P>0.05). Conclusion: The high-throughput hemodialysis department significantly improved renal anemia in hemodialysis patients, reduced serum sTfR level, and had fewer adverse reactions and higher safety.

Correlation of serum vitamin C content with renal anemia,oxidative stress and microinflammatory state in patients with peritoneal dialysis

Objective: To study the correlation of serum vitamin C content with renal anemia, oxidative stress and microinflammatory state in patients with peritoneal dialysis. Methods: A total of 96 patients undergoing peritoneal dialysis in the First Affiliated Hospital of Soochow University between January 2016 and January 2017 were selected as the peritoneal dialysis group, and 50 healthy volunteers receiving physical examination in the First Affiliated Hospital of Soochow University during the same period were selected as the normal control group. The contents of VitC as well as renal anemia, oxidative stress and microinflammation-related indexes in peripheral blood of two groups of subjects were detected, and Pearson test was used to evaluate the correlation of serum VitC content with renal anemia, oxidative stress and microinflammatory state in patients with peritoneal dialysis. Results: VitC content in peripheral blood of peritoneal dialysis group was lower than that of normal control group;renal anemia-related indexes Hb, RBC and TIBC levels in peripheral blood were lower than those of normal control group;oxidative stress indexes LHP, MPO and AOPPs contents in serum were higher than those of control group while SOD and GSH-Px contents were lower than those of control group;inflammatory factors CRP, IL-6, IL-8, IL-10 and IL-13 contents in serum were higher than those of normal control group. VitC content in serum of patients with peritoneal dialysis was positively correlated with Hb, RBC, TIBC, SOD and GSH-Px levels, and negatively correlated with LHP, MPO, AOPPs, CRP, IL-6, IL-8, IL-10 and IL-13 contents. Conclusion: Serum VitC content is lower in patients with peritoneal dialysis, and the specific content is directly correlated with the severity of renal anemia, oxidative stress and microinflammatory state.

Risk stratification of renal transplant recipients using routine parameters: Implication of learning from SARS-CoV-2 into transplant follow-up program

BACKGROUND Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection is a global pandemic that is associated with a high risk of morbidity and mortality among recipients of solid organ transplantation.In the course of acute SARS-CoV-2 infection,various laboratory markers have been identified as predictors for high risk of mortality.AIM To risk stratify renal transplant recipients(RTxR)using general demographic parameters,comorbidities and routine laboratory markers for the severity of the disease and its outcomes.We believe that learning about these routinely monitored parameters can help us plan better strategies for the RTxR follow-up program.METHODS This present study includes RTxR who acquired SARS-CoV-2 infection from March 2020 to February 2021.We recorded the basic demographics,comorbidities and routine laboratory markers.We investigated the impact of SARS-CoV-2 infection on RTxRs and risk-stratified the progression of disease severity and outcomes in terms of recovery or mortality.RESULTS From 505 RTxRs in our renal transplant follow-up program,29(7.75%)RTxRs had PCR-positive SARS-CoV-2 infection.We recorded 8 deaths from SARS-CoV-2 infection giving an overall mortality rate of 1.6%but a significant 27.6%mortality in SARS-CoV-2 positive recipients.Age more than 68 years,non-Caucasian ethnicity and male gender were associated with a significant drop in survival probability;P≤0.001.<0.001 and<0.0001 respectively.87.5%of the deceased were diabetic;P≤0.0.0001.Estimated glomerular filtration rate of less than 26 mL/min/1.73 m2,serum albumin less than 20 g/L,Hemoglobin less than 9.6 g/L and serum calcium less than 1.70 mmol/L were all associated with significantly increased risk of mortality;P=0.0128,<0.001,<0.0001 and 0.0061 respectively.CONCLUSION This study has identified some routinely used modifiable parameters in predicting a higher risk of mortality and morbidity.This knowledge can be used in RTxR follow-up programs by addressing these parameters early to help reduce the morbidity and mortality in RTxRs.

罗沙司他治疗腹膜透析贫血疗效及对腹膜转运能力变化的影响

目的观察罗沙司他治疗腹膜透析贫血的疗效及其对腹膜溶质转运能力变化的影响。方法纳入新疆医科大学第五附属医院和新疆维吾尔自治区人民医院2022年1月至2023年1月接受规律腹膜透析贫血的患者100例,随机分为试验组(55例)、对照组(45例),分别使用罗沙司他和促红素注射液治疗。比较治疗前后试验组和对照组的贫血指标、铁代谢指标、炎症指标、腹膜溶质转运能力。结果①治疗8周后,两组患者贫血情况均较治疗前改善(P<0.05)。试验组贫血治疗总有效率略高于对照组(87.04%vs.84.44%),但差异无统计学意义(P>0.05)。②两组患者血清铁蛋白均低于100μg/L,转铁状态蛋白饱和度均>20%,血清铁浓度均处于正常范围,治疗前以及治疗后组间比较差异均无统计学意义(P>0.05)。③治疗前后的C反应蛋白(CRP)中位数均处于正常范围内,但试验组治疗后水平增高,差异有统计学意义(P<0.05)。④两组患者腹膜溶质转运能力中位数水平较治疗前轻度增高(P<0.05),但两组患者腹膜转运能力比较,差异无统计学意义(P>0.05)。结论罗沙司他可以在轻微炎症状态下有效改善腹膜透析患者血红蛋白水平,轻度增加患者腹膜溶质转运能力。罗沙司他与促红素注射液纠正贫血能力和影响腹膜溶质转运能力方面作用相当。

罗沙司他治疗肾性贫血不良反应的研究进展

罗沙司他是治疗肾性贫血的一种新型口服药物,主要通过作用于缺氧诱导因子(HIF)通路,促进内源性促红细胞生成素(EPO)的产生及其受体的表达,优化铁的利用等机制,起到升高血红蛋白的作用。然而,罗沙司他在纠正肾性贫血的同时,可能导致深静脉血栓形成、动静脉内瘘血栓形成、高血压、高钾血症等不良反应风险的增加。因此,临床应用罗沙司他时,应加强对患者血管通路、血压、电解质等的监测,及时发现和处理相关不良反应,确保患者的用药安全。

泄浊养血法联合重组人促红素注射液治疗肾虚湿浊型慢性肾脏病3~5期肾性贫血患者的临床观察

[目的]观察泄浊养血法联合重组人促红素注射液对慢性肾脏病(CKD)3~5期肾性贫血患者贫血改善及残余肾功能的干预作用。[方法]选择2020年10月—2021年10月就诊于天津中医药大学第一附属医院的88例CKD 3~5期肾性贫血患者,根据随机数字表法随机分为对照组(44例)和治疗组(44例)。对照组予重组人促红细胞生成素注射液及多糖铁复合物治疗,治疗组在此基础上联合泄浊养血法中药方治疗,连续服用3个月,观察治疗前后两组临床疗效、红细胞计数(RBC)、血红蛋白(Hb)、血清肌酐(Scr)、尿素氮(BUN)、肾小球滤过率(eGFR)、尿微量白蛋白(mALB)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)的变化,症状积分及不良反应发生率。[结果]治疗3个月后,治疗组总有效率为86.36%,对照组为56.82%,治疗组临床疗效优于对照组(P<0.05);症状积分、RBC、Hb、Scr、BUN、mALB均较治疗前改善,且治疗组优于对照组(P<0.05);安全性指标中AST、ALT治疗前后数值变化,差异无统计学意义(P>0.05)。两组病例中均未出现不良反应。[结论]泄浊养血法联合重组人促红细胞生成素注射液治疗可以改善CKD 3~5期非透析肾性贫血患者临床症状,提高临床疗效,延缓肾功能进展,且具有一定的安全性。

慢性肾功能衰竭腹膜透析患者发生肾性贫血的风险及其预测模型构建

目的探究慢性肾功能衰竭(CRF)腹膜透析患者发生肾性贫血的风险,并建立风险预测模型。方法回顾性分析2018年7月至2021年6月吉安市中心人民医院收治的106例行腹膜透析CRF患者的临床资料,根据肾性贫血发生情况分为肾性贫血组与未发生肾性贫血组,各53例。比较两组肾性贫血相关因子水平[红细胞计数(RBC)、血红蛋白(Hb)、白蛋白(Alb)、C反应蛋白(CRP)、转铁蛋白(TRF)、转铁蛋白饱和度(TSAT)、血清总铁结合力(TIBC)、不饱和铁结合力(UIBC)],Logistic回归分析腹膜透析患者发生肾性贫血的危险因素,建立预测模型并评估其预测效能。结果肾性贫血组RBC、Hb、Alb、CRP、TRF、TSAT、TIBC、UIBC水平均低于未发生肾性贫血组,差异有统计学意义(P<0.05)。Logistic回归分析显示,TRF、TIBC、UIBC是发生肾性贫血的危险因素(P<0.05),ROC曲线显示AUC分别为0.815、0.919和0.826。肾性贫血风险预测模型验证结果显示,74例患者TRF、TIBC、UIBC的准确度为85.1%、86.5%、89.2%。结论TRF、TIBC、UIBC是发生肾性贫血的危险因素,且风险预测模型对肾性贫血发生预测效能较好。

血液红细胞及网织红细胞参数对肾性贫血患者的临床检验价值

目的探究在肾性贫血检验中,血液红细胞及网织红细胞水平的检验意义。方法选取2022年3月至2024年3月期间我院收治的肾性贫血患者45例与非肾性贫血的贫血患者45例纳为研究对象,将肾性贫血患者设为试验组,将非肾性贫血的贫血患者设为对照组,两组患者均接受血液红细胞检测,对比分析两组患者的血液红细胞和网织红细胞参数水平,为临床检验提供医学参考。结果两组患者的平均红细胞血红蛋白浓度(MCHC)、红细胞压积(HCT)、红细胞体积分布宽度变异系数(RDW-CV)、红细胞体积分布宽度标准差(RDW-SD)水平对比差异无统计学意义(P>0.05);试验组患者的平均红细胞血红蛋白量(MCH)和平均红细胞体积(MCV)水平高于对照组,红细胞计数(RBC)水平低于对照组(均P<0.05)。两组患者的血红蛋白(Hb)参数对比差异无统计学意义(P>0.05);试验组患者的低散射网织红细胞百分比(LFR)高于对照组,网织红细胞绝对值(RET#)、网织红细胞百分比(RET%)、未成熟网织红细胞指数(IRF)、中散射网织红细胞百分比(MFR)以及高散射网织红细胞(HFR)均低于对照组(均P<0.05)。结论在肾性贫血患者临床检验中,通过血液红细胞及网织红细胞参数可了解肾性贫血患者病情及贫血程度,为疾病的初期诊断和分析治疗效果提供切实的参考依据,临床检验价值较高。

罗沙司他联合右旋糖酐铁治疗非透析依赖性慢性肾脏病肾性贫血患者的效果

目的:观察罗沙司他联合右旋糖酐铁治疗非透析依赖性慢性肾脏病肾性贫血患者的效果。方法:回顾性分析2020年6月至2023年4月该院收治的198例非透析依赖性慢性肾脏病肾性贫血患者的临床资料,按照治疗方法不同将其分为对照组和观察组各99例。对照组采用右旋糖酐铁治疗,观察组在对照组基础上联合罗沙司他治疗,两组均连续治疗12周。比较两组临床疗效,治疗前后血常规指标[血红蛋白(Hb)、红细胞计数(RBC)]水平、血清铁蛋白(SF)水平、炎性因子[C反应蛋白(CRP)、白细胞介素-6(IL-6)]水平,以及不良反应发生率。结果:观察组治疗总有效率为95.96%(95/99),高于对照组的84.85%(84/99),差异有统计学意义(P<0.05);治疗后,观察组Hb、RBC、SF水平均高于对照组,差异有统计学意义(P<0.05);治疗后,观察组CRP、IL-6水平均低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:罗沙司他联合右旋糖酐铁治疗非透析依赖性慢性肾脏病肾性贫血患者可提高治疗总有效率、血常规指标水平和SF水平,降低炎性因子水平,效果优于单纯右旋糖酐铁治疗。

罗沙司他与大剂量rHuEPO治疗腹膜透析肾性贫血患者的效果及安全性

目的:探讨罗沙司他与大剂量重组人促红素(rHuEPO)治疗腹膜透析肾性贫血患者的效果及安全性。方法:选择萍乡市人民医院2022年7—12月收治的60例腹膜透析肾性贫血患者进行本次研究,按照随机数字表法分为两组,各30例。对照组采用大剂量rHuEPO治疗,研究组采用大剂量rHuEPO联合罗沙司他治疗。对比两组疗效和治疗前后肾功能指标[血尿素氮(BUN)、血肌酐(Scr)、β_(2)-微球蛋白(β_(2)-MG)]、血液营养指标[血红蛋白(Hb)、红细胞压积(HCT)、红细胞(RBC)计数]、甲状旁腺激素(PTH)、铁代谢指标[血清铁蛋白(SF)、转铁蛋白饱和度(TSAT)]及不良反应。结果:治疗后,研究组总有效率为90.00%,显著高于对照组的63.33%,差异有统计学意义(P<0.05);治疗后,研究组Hb、HCT、RBC均显著高于对照组,PTH显著低于对照组,差异均有统计学意义(P<0.05);治疗后,研究组SF、TSAT均显著高于对照组(P<0.05);治疗后,研究组BUN、Scr、β_(2)-MG均显著低于对照组,差异均有统计学意义(P<0.05)。结论:罗沙司他联合大剂量rHuEPO治疗可有效改善腹膜透析肾性贫血患者的贫血情况,纠正铁代谢,且不良反应少。

重组人促红细胞生长素联合维生素D治疗对腹膜透析肾性贫血患者的影响

目的:研究重组人促红细胞生长素联合维生素D治疗腹膜透析肾性贫血患者的影响。方法:选取2022年1月—2023年6月于晋江市医院进行诊治的120例腹膜透析肾性贫血患者,按照随机数表法分为观察组[活性维生素D(骨化三醇)+重组人促红细胞生长素注射治疗]和对照组(应用重组人促红细胞生长素注射治疗),各60例。比较两组治疗前后血细胞情况[血红蛋白(Hb)、红细胞计数(RBC)、红细胞压积(HCT)]、铁代谢指标[血清铁调素、血清铁(SI)、血清铁蛋白(SF)]、甲状腺激素水平[血游离三碘甲状腺原氨酸(FT_(3))、血游离甲状腺素(FT_(4))、促甲状腺素(TSH)、全段甲状旁腺激素(PTH)]及不良反应发生情况。结果:治疗后,两组Hb、RBC和HCT水平均高于治疗前,且观察组Hb和RBC水平高于对照组,差异有统计学意义(P<0.05)。治疗后,两组血清铁调素、SF低于治疗前,SI高于治疗前,且观察组血清铁调素、SF低于对照组,SI高于对照组,差异有统计学意义(P<0.05)。治疗后,两组TSH、FT_(3)、FT_(4)高于治疗前,PTH低于治疗前,且观察组TSH、FT_(4)高于对照组,PTH低于对照组,差异有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(χ^(2)=1.345,P=0.246)。结论:重组人促红细胞生长素联合维生素D治疗可显著改善腹膜透析肾性贫血患者血细胞指标,调节铁代谢及甲状腺激素水平,且未见明显不良反应。

伴贫血IgA肾病临床病理及预后研究

目的探讨贫血与IgA肾病临床、牛津病理分型及肾脏预后的关系,明确贫血是否为IgA肾病进展的危险因素。方法选取2020年1月至2021年1月首次就诊山西医科大学第二医院并完善经皮肾穿刺活检术后诊断为IgA肾病病人为研究对象。据血红蛋白(Hb)情况将病人分为贫血组和Hb正常组。生存分析采用Kapian-Meier法。比较两组临床特征、牛津病理(M、S、E、T)分型及肾存活率的差异。通过二元logistic回归方法分析贫血的影响因素。结果贫血组血肌酐(Scr)[171.50(76.75,253.25)μmol/L比76.50(64,90.75)μmol/L]、24 h尿蛋白定量[2.49(1.24,4.07)g/d比1.55(0.92,2.79)g/d]、慢性肾脏病(CKD)分期较Hb正常组高,肾小球滤过率(eGFR)[36.50(21.75,96.25)mL·min^(-1)·(1.73 m^(2))^(-1)比103(89.75,119.25)mL·min^(-1)·(1.73 m^(2))-1]、血清白蛋白(Alb)[(31.90±6.95)g/L比(37.81±6.89)g/L]较Hb正常组低(P<0.05)。牛津病理(M、S、E、T)分型比较,贫血组E、T分型较Hb正常组高(P<0.05)。Kapian-Meier生存分析结果显示,贫血组肾存活率较HB正常组低(38.9%比75.0%,P<0.05)。回归分析结果显示牛津病理(T)分型是IgA肾病合并贫血的独立危险因素,eGFR和ALB是IgA肾病合并贫血的保护因素(P<0.05)。结论贫血是IgA肾病病人的常见并发症。在IgA肾病病人中,贫血与肾功能下降、肾脏不良预后及间质损伤之间有显著相关性。贫血可能为IgA肾病进展的独立危险因素。