유지혈액투석 환자에서 프로토콜에 의한 Erythropoietin 투여의 유용성 = Efficacy of Protocol-based Erythropoietin Administration in Chronic Hemodialysis Patients

다국어 초록 (Multilingual Abstract)

Hemodialysis Unit & Division of Nephrology*, Guro Hospital, College of Medicine, Korea University, Seoul, Korea Background:Anemia is a major contributor to morbidity and mortality in chronic renal failure patients. The benefits of anemia correction using recombinant human erythropoietin (Epo) are well established but because of high cost, several studies increasing the efficacy of it were described. The objective of this study was to evaluate the efficacy of an anemia management protocol using subcutaneous Epo and intravenous iron therapy.
Methods:We enrolled seventy-eight maintenance hemodialysis patients for at least 3 months from January 2000 to November 2002. They received a practice of anemia correction in two other settings. One (control) group performed an irregular administration of Epo and iron, the other (protocol) group performed a regular administration according to anemia management protocol. Clinical and laboratory parameters were analyzed. Dosage of Epo and IV iron were compared.
Results:Thirty-one patients in control group and forty-seven patients in protocol group were enrolled. There were no significant differences between two groups in age, gender, existence of diabetic mellitus, vintage of hemodialysis, use of angiotensin-converting enzyme inhibitor, BUN, prealbumin, parathyroid hormone and Kt/Vurea. Mean arterial pressure, creatinine and albumin were significantly lower and hematocrit was significantly higher and well-maintained on the target level in protocol group. There were no significant differences in serum iron, transferrin saturation, ferritin but total iron binding capacity was significantly lower in protocol group. Doses of erythropoietin and IV iron showed no significant differences between two groups.
Conclusion:The protocol based erythropoietin administration was more efficient in achieving target hematocrit without increment of dosage of erythropoietin and intravenous iron and side effect of hypertension.

국문 초록 (Abstract)

목 적:만성신부전 환자의 빈혈은 주요한 이환과 사망의 원인으로 erythropoietin의 상용화로 치료에 큰 발전이 있었으나, 고가 약제인 이유로 투여의 효율성을 높이고자 하는 여러 연구가 있어왔다. 이에 프로토콜에 의한 erythropoietin, 철분제의 투여로 그 효율성을 평가하고자 하였다.
방 법:2000년 1월부터 2002년 11월까지 고려의대 구로병원에서 유지혈액투석 중인 환자 78명을 대상으로 불규칙적으로 erythropoietin과 철분제를 투여 받은 환자군 (Control group)과 3개월 이상 프로토콜에 따라 규칙적으로 erythropoietin과 철분제를 투여 받은 환자군 (Protocol group) 간의 성별, 연령, 당뇨병의 유무, 혈액투석 기간, 안지오텐신 전환 효소 억제제의 사용 빈도, 평균동맥압, 투석 전 혈중 요소질소, 크레아티닌, 알부민, prealbumin, 부갑상선 호르몬 농도, 투석적절도 및 혈색소와 헤마토크리트, 혈청 철, 총 철분 결합능, transferrin 포화도, ferritin, erythropoietin과 정주용 철분제의 투여량 등을 비교 분석하였다.
결 과:대조군 31명, 프로토콜군 47명이었고, 두 군의 연령, 성별, 당뇨병의 유무, 혈액투석 기간, 안지오텐신 전환 효소 억제제의 사용 빈도, 혈중 요소질소, prealbumin, 부갑상선 호르몬 농도, 투석적절도 등은 차이가 없었다. 프로토콜군이 평균동맥압 (104.29 vs. 99.74, mmHg), 크레아티닌 (11.01 vs. 9.48, mg/dL), 알부민 (4.08 vs. 3.83, g/dL)이 낮았으나, 혈색소 (9.63 vs 11.16, g/dL, p=0.000), 헤마토크리트 (28.14 vs. 33.17, %, p=0.000)는 유의하게 높았으며, 혈색소 11.0-12.0 mg/dL, 헤마토크리트 33.0-36.0% 사이에서 잘 유지되었다. 혈청 철, transferrin 포화도, ferritin은 두 군이 차이가 없었고, 프로토콜군이 총 철분 결합능 (264.16 vs. 224.86, mg/dL, p=0.000)이 낮았다. 투여된 erythropoietin, 정주용 철분제의 용량은 유의한 차이는 없었으며, 프로토콜군이 erythropoietin 투여량이 일정 수준 사이에서 유지되었다.

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