Predictors of haemoglobin levels and resistance to erythropoiesis-stimulating agents in patients treated with low-flux haemodialysis, haemofiltration and haemodiafiltration: results of a multicentre randomized and controlled trial
| Autor: | Rocco Ferrara, Carlo Basile, Giuseppe Villa, Biagio Di Iorio, Paolo Altieri, Francesco Cadinu, Francesco Logias, Simeone Andrulli, Piergiorgio Bolasco, Mariano Feriani, Francesco Locatelli, Carmine Zoccali, Salvatore David, Mario Passaghe, Domenica Casu, Luciano A. Pedrini, Renzo Tarchini, Gianfranco Fundoni, Pier Eugenio Nebiolo, Giovanna Sau |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Drug Resistance Hemodiafiltration Drug resistance law.invention Hemoglobins Young Adult Randomized controlled trial Renal Dialysis Risk Factors law Internal medicine Intra- and Extracorporeal Treatments of Kidney Failure Hemofiltration online haemodiafiltration medicine Humans In patient Intensive care medicine Aged Aged 80 and over Transplantation biology business.industry C-reactive protein Middle Aged Clinical Science Prognosis medicine.disease haemoglobin haemodialysis ESA resistance online haemofiltration Nephrology Heart failure Hematinics biology.protein Erythropoiesis Female Kidney Diseases Hemodialysis business Follow-Up Studies |
| Zdroj: | Nephrology Dialysis Transplantation |
| ISSN: | 1460-2385 0931-0509 |
| DOI: | 10.1093/ndt/gfs117 |
| Popis: | Background Predictors of haemoglobin (Hb) levels and resistance to erythropoiesis-stimulating agents (ESAs) in dialysis patients have not yet been clearly defined. Some mainly uncontrolled studies suggest that online haemodiafiltration (HDF) may have a beneficial effect on Hb, whereas no data are available concerning online haemofiltration (HF). The objectives of this study were to evaluate the effects of convective treatments (CTs) on Hb levels and ESA resistance in comparison with low-flux haemodialysis (HD) and to evaluate the predictors of these outcomes. Methods Primary multivariate analysis was made of a pre-specified secondary outcome of a multicentre, open-label, randomized controlled study in which 146 chronic HD patients from 27 Italian centres were randomly assigned to HD (70 patients) or CTs: online pre-dilution HF (36 patients) or online pre-dilution HDF (40 patients). Results CTs did not affect Hb levels (P = 0.596) or ESA resistance (P = 0.984). Hb correlated with polycystic kidney disease (P = 0.001), C-reactive protein (P = 0.025), ferritin (P = 0.018), ESA dose (P < 0.001) and total cholesterol (P = 0.021). The participating centres were the main source of Hb variability (partial eta2 0.313, P < 0.001). ESA resistance directly correlated with serum ferritin (P = 0.030) and beta2 microglobulin (P = 0.065); participating centres were again a major source of variance (partial eta2 0.367, P < 0.001). Transferrin saturation did not predict either outcome variables (P = 0.277 and P = 0.170). Conclusions In comparison with low-flux HD, CTs did not significantly improve Hb levels or ESA resistance. The main sources of variability were participating centres, ESA dose and the underlying disease. |
| Databáze: | OpenAIRE |
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