个体化贫血治疗对血红蛋白稳定性的影响:针对血液透析患者的随机对照试验。

IF 8.5 1区 医学 Q1 UROLOGY & NEPHROLOGY Clinical Journal of the American Society of Nephrology Pub Date : 2024-06-11 DOI:10.2215/CJN.0000000000000488
Doris H Fuertinger, Lin-Chun Wang, David J Jörg, Lemuel Rivera Fuentes, Xiaoling Ye, Sabrina Casper, Hanjie Zhang, Ariella Mermelstein, Alhaji Cherif, Kevin Ho, Jochen G Raimann, Lela Tisdale, Peter Kotanko, Stephan Thijssen
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引用次数: 0

摘要

背景:贫血在血液透析患者中很常见。将血红蛋白水平稳定在预定目标水平内具有挑战性,尤其是对于血红蛋白波动频繁,既高于又低于预期目标的患者。我们进行了一项多中心随机对照试验,将我们的贫血治疗辅助软件与基于人群的标准贫血治疗方案进行比较。我们假设个性化的促红细胞生成药(ESA)剂量能提高血红蛋白的达标率:96名接受血液透析和甲氧基聚乙二醇-表皮生长因 beta 的患者按 1:1 随机分配到干预组(由软件计算的个性化 ESA 剂量建议)或标准护理组,为期 26 周。治疗辅助软件结合了基于生理学的数学模型和模型预测控制器,旨在将血红蛋白水平稳定在严格的目标范围内(10 至 11 g/dl)。主要结果指标是血红蛋白测量值在目标范围内的百分比。次要结果指标包括血红蛋白变异性和ESA使用率:干预组血红蛋白测量值在目标范围内的百分比中位数提高到 47%(IQR 39 至 58),两组之间的中位数差异为 10 个百分点(95% CI:3 至 16;P=0.008)。标准护理组与接受个性化 ESA 建议组相比,血红蛋白达标的几率比为 0.68(95% CI:0.51 至 0.92)。干预组患者的血红蛋白水平变异性降低,出现血红蛋白水平波动的患者比例为 45%,而标准护理组为 82%。干预组的ESA用量减少了约25%:我们的研究结果表明,通过使用基于生理学的贫血治疗辅助软件提供个性化的 ESA 建议,血红蛋白目标的实现率和波动率都有所提高。
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Effects of Individualized Anemia Therapy on Hemoglobin Stability: A Randomized Controlled Pilot Trial in Patients on Hemodialysis.
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来源期刊
CiteScore
12.20
自引率
3.10%
发文量
514
审稿时长
3-6 weeks
期刊介绍: The Clinical Journal of the American Society of Nephrology strives to establish itself as the foremost authority in communicating and influencing advances in clinical nephrology by (1) swiftly and effectively disseminating pivotal developments in clinical and translational research in nephrology, encompassing innovations in research methods and care delivery; (2) providing context for these advances in relation to future research directions and patient care; and (3) becoming a key voice on issues with potential implications for the clinical practice of nephrology, particularly within the United States. Original manuscript topics cover a range of areas, including Acid/Base and Electrolyte Disorders, Acute Kidney Injury and ICU Nephrology, Chronic Kidney Disease, Clinical Nephrology, Cystic Kidney Disease, Diabetes and the Kidney, Genetics, Geriatric and Palliative Nephrology, Glomerular and Tubulointerstitial Diseases, Hypertension, Maintenance Dialysis, Mineral Metabolism, Nephrolithiasis, and Transplantation.
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