血液透析患者の腎性貧血に対する遺伝子組換えヒトエリスロポエチン製剤（ｒＨｕＥＰＯ）治療における維持Ｈｔ値と生命予後に関する大規模調査（ｒＨｕＥＰＯ特別調査）

DOI 被引用文献4件 参考文献11件

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  • Maintenance hamatocrit levels and mortality in hemodialysis patients with renal anemia receiving recombinant human erythropoietin(rHuEPO) treatment(rHuEPO survey).

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A total of 2, 654 maintenance hemodialysis patients with at feast 6 months history of dialysis, who had been continuously treated with recombinant human erythropoietin (rHuEPO) over 6 months, were included in this study. The association between maintenance hematocrit levels and patient mortality was retrospectively studied. A Cox regression analysis was performed to evaluate mortality risks. Patients with hematocrit values of 30% to <33% exhibited significantly lower 1-year mortality risk (0.447 [95% confidence intervals (CI): 0.290-0.689] p=0.0003), when compared to patients with the reference hematocrit range, 27% to <30% (reference group) [Relative Risk (RR): 1.000]. However, there was no significant difference in the 1-year mortality risk between patients with hematocrit values of 33% to <36% (0.605 [95% CI: 0.320-1.146] p=0.1231) and the reference group. On the other hand, compared to the reference group, patients with hematocrit values of <27% exhibited significantly higher risk of death during the 1-year follow-up period (1.657 [95% CI: 1.161-2.367] p=0.0054). A similar pattern was observed for 3-year mortality risks. Compared to the reference group, patients with hematocrit values of 30% to <33% exhibited significantly lower 3-year mortality risk (0.677 [95% CI: 0.537-0.855] p=0.0010). However, there was no significant difference in 3-year mortality risk between patients with hematocrit values of 33% to <36% (1.111 [95% CI: 0.816-1.514] p=0.5036) and the reference group. Compared to the reference group, patients with hematocrit values of <27% exhibited significantly higher risk of death during the 3-year follow-up period (1.604 [95% CI: 1.275-2.019] p<0.0001).<br>These observations demonstrate that patients with hematocrit values of 30% to less than 33% have significantly lower risk for 1-year and 3-year mortality, when compared to patients with hematocrit values of 27% to <30%. Based on mortality, our findings suggest that the maintenance hematocrit level of 30% to less than 33% is favorable for hemodialysis patients with rHuEPO treatment. Though there were few patients with hematocrit values of 33% or higher, these patients exhibited lower risk of death during the 1-year follow-up period. Further study is needed to clarify the benefit of these high hematocrit levels.

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