中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (03): 158-161.doi: 10.3969/j.issn.1671-4091.2022.03.004

• 临床研究 • 上一篇    下一篇

红细胞生成素联合低剂量罗沙司他治疗血液透析患者肾性贫血的初步分析

王松1,毕书红1,白琼1,潘月娟1,蒋真斌1,王悦1   

  1.  1北京大学第三医院肾内科
  • 收稿日期:2021-11-15 修回日期:2021-12-27 出版日期:2022-03-12 发布日期:2022-03-16
  • 通讯作者: 王悦 bjwangyue@sina.com E-mail:bjwangyue@sina.com

The effectiveness and safety of combined use of erythropoietin and low dose Roxadustat in the treatment of renal anemia in hemodialysis patients

  1. 1Department of Nephrology, Peking University Third Hospital, Beijing 100191, China
  • Received:2021-11-15 Revised:2021-12-27 Online:2022-03-12 Published:2022-03-16
  • Contact: Yue WANG E-mail:bjwangyue@sina.com

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摘要： 【摘要】目的探讨红细胞生成素(erythropoietin，EPO)联合低剂量罗沙司他治疗单用EPO 血红蛋白(Hb)未能维持靶目标的血液透析患者肾性贫血的效果。方法纳入2020 年1 月～2021 年9 月北京大学第三医院血液透析患者中，单用EPO 不能维持Hb 在靶目标范围、增加EPO 剂量存在风险或EPO 已经超剂量、全部改用罗沙司他费用承担困难者，分析联合治疗前、后各6 个月Hb 水平的变化，罗沙司他和EPO 剂量、透析方案、铁剂补充以及超敏C 反应蛋白(us-CRP)、甲状旁腺激素(iPTH)、酸中毒程度(CO2CP)的变化。结果共38 例患者接受了联合治疗，加用罗沙司他之前6 月较前3 月、前3 月较0 月，Hb 逐渐降低(t=6.689、4.910，均P＜0.001)，EPO 剂量无显著变化(t=-1.686、-1.937，P=0.102、0.088)，转铁蛋白饱和度(TSAT)、铁蛋白(SF)处于目标范围；联合低剂量罗沙司他[(211.9± 12.5)mg/w]后1 月、3 月、6 月分别较0 月时，EPO 剂量较联合治疗前无显著性改变(t=0.583、-1.303、-1.402，P=0.563、0.201、0.180)，联合治疗后1、3、6 个月Hb 分别较0 月时逐渐提高(t=-4.788、-5.162、-5.910，均P＜0.001)，TSAT 出现下降但未达到统计学差异(t=1.967，P=0.064)，铁蛋白显著性降低(t=2.259，P=0.037)；联合治疗前后，透析方案、静脉铁剂的剂量无变化，us-CRP、iPTH、CO2CP 无显著差异(t=-1.989、-1.743、0.946，P=0.427、0.464、0.352)，未见明显不良事件。结论对于单用EPO 不能维持Hb 靶目标的血液透析患者，联合使用低剂量罗沙司他安全有效。

关键词: 肾性贫血, 血液透析, 红细胞生成素, 罗沙司他

Abstract: 【Abstract】Objective To investigate the effectiveness and safety of erythropoietin (EPO) combined with low dose Roxadustat in hemodialysis patients whose hemoglobin (Hb) levels remained below the target range under EPO therapy. Methods The hemodialysis patients treated in Peking University Third Hospital from January 2020 to September 2021 and having renal anemia not to be reversed to the target range by EPO were retrospectively reviewed. Their EPO dose could not be further increased because of the already higher EPO dose they took, the possible side-effects of high EPO dose, or the unaffordable cost of Roxadustat of the patients. The changes of Hb level, doses of EPO and Roxadustat, dialysis regimens, iron supplements, ultrasensitive C-reactive protein (us-CRP), intact parathyroid hormone (iPTH), acidosis (CO2CP), and others before the combined therapy and after 6 months of the therapy were analyzed. Results A total of 38 patients received combined therapy. The Hb gradually decreased in the 6 months before the addition of Roxadustat compared with the 3 months and the 0 months (t=6.689, 4.910, respectively，both P<0.001). EPO dose did not change significantly (t=-1.686, -1.937, P=0.102, 0.088, respectively). Transferrin saturation (TSAT) and ferritin (SF) were in the target range. After the combination therapy with low-dose Roxadustat [(211.9 ±12.5) mg/week] for 1, 3 and 6 months, the dose of EPO had no significant change compared with month 0 (t=0.583, -1.303, - 1.402, P=0.563, 0.201, 0.180). Hb gradually increased at 1, 3 and 6 months after combined treatment (t=-4.788, -5.162, -5.910, respectively. P<0.001 in all). TSAT decreased slightly without statistically significance (t=1.967, P=0.064); SF decreased significantly (t=2.259, P=0.037). Before and after the combined therapy, dialysis regimen and intravenous iron dose had no changes; us-CRP, iPTH, and CO2CP levels also had no changes (t=-1.989, -1.743 and 0.946 respectively; P=0.427, 0.464 and 0.352 respectively). No adverse events were found during the combined therapy. Conclusion For hemodialysis patients who cannot maintain the Hb target with EPO alone, combined use of low-dose Roxadustat is safe and effective.

Key words: Renal anemia, Hemodialysis, Erythropoietin, Roxadustat

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