ESA抵抗的原因及处理.ppt

* 40 In the Wave 2 of the DMMS, patients were asked about the process of selection of dialysis modality. 52% of patients responded that the medical team took the lead in selecting their treatment, whereas in only 18% did the patient took the lead and in 31% it was a joint decision. USRDS 1997 Annual Data Report * McClellan WM et al. J Am Soc Nephrol 2000; 11: 287A Movilli E et al. Nephrol Dial Transplant 2001; 16: 111–16 透析不充分 7092例美国血透病人随机样本分析透析剂量(URR)与Hct和促红素剂量的相关性(p 0.001) 促红素剂量与URR呈反比 (p 0.001) Hct与URR直接相关(P 0.001) Kt/v增加，促红素需要量减少 (r = -0.49; p 0.0001) 0 400 1.0 1.2 1.4 1.6 1.8 2.0 300 200 100 n = 68 r = -0.49 p 0.0001 rh-EPO dose (U/kg/week) Kt/V Movilli E et al. (2001) 透析影响促红素疗效的因素 水质和水供应系统 透析液 透析剂量和频率 透析膜和超滤治疗 联机HDF Richardson D et al. Nephrol Dial Transplant 1999; 14: 2625–7 透析液氯胺引起的促红素低反应性 % patients (Hb 10 g/dl) 0 100 0 80 60 40 20 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Months Charcoalfilterinsertion rh-EPO and intravenous iron increase 无致热原透析液和促红素反应一项前瞻性、随机研究 目的：比较两种透析液对促红素疗效的作用 病人：15例常规血液透析 15例转成联机产生的超纯水透析液 随访：12个月 结果：超纯水显著降低了促红素剂量 无致热原透析液和促红素剂量 40 160 5 10 15 20 25 55 140 120 100 80 60 n = 30 r2 = 0.675 rh-EPO(U/kg/week) IL-6 (pg/ml ) 30 35 40 45 50 Sitter T et al. Nephrol Dial Transplant 2000; 15: 1207–11 血透强度与促红素反应 目的：对透析剂量增加(高通量聚砜膜)和常规透析(改良醋酸纤维素膜)进行比较 设计：前瞻性、非随机 病人：每组各20例，随访6周 结果：Hct水平 26 34 30 0 32 28 2 4 6 Weeks 透析剂量增加(高通量聚砜膜) n = 20 常规透析剂量(纤维素膜)n = 20 Ifudu O et al. N Engl J Med 1996; 334: 420–25 透析强度对血细胞的作用 Hct (%) 54 70 62 -4 66 58 0 4 8 Cellulose membrane(n = 16) Villaverde M et al. Nefrologia 1999; 19: 161–7 高通量聚砜膜与促红素反应 rh-EPO dose (IU/kg/week) High-flux PSF(n = 31) Months 0 2.5 0.5 1.5 1.0 2.0 Locatelli F et al. Kidney Int 1996; 50: 1293–302 贫血与血透治疗 Hct variation (%) -0.5 High-flux p = 0.016 0 12 18 24 Low-flux 6 Months Maduell F et al. Nephrol Dial Transplant 1999; 14: 1202–7 n = 37 * p 0.05 促 红 素 剂 量 rh-EPO (IU/week) 2500 4000 0 3500 3000 1 2 3 4 5 6 7 8 9 10 11 12 * * * * * * * * * * Months 常规透析改为联机HDF 透析与促红素疗效结论 透