Variação dos níveis de hemoglobina de pacientes em hemodiálise tratados com eritropoetina: uma experiência brasileira

• Autor(a) principal: Ammirati, Adriano Luiz [UNIFESP]
• Data de Publicação: 2010
• Outros Autores: Watanabe, Renato [UNIFESP], Aoqui, Cristiane [UNIFESP], Draibe, Sergio Antonio [UNIFESP], Carvalho, Aluizio Barbosa de [UNIFESP], Abensur, Hugo, Drumond, Soraia Stael, Moreira, João, Bevilacqua, José Luis, Silva, Anita Cm, Tatsch, Fernando, Canziani, Maria Eugênia Fernandes [UNIFESP]
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: http://dx.doi.org/10.1590/S0104-42302010000200021; http://repositorio.unifesp.br/handle/11600/5453
• topic: Anemia; Erythropoietin; Recombinant; Kidney failure; Chronic; Anemia; Eritropoetina recombinante; Falência renal crônica

OBJECTIVE: Correction of anemia using epoetin decreases morbidity and increases survival and quality of life in end-stage renal disease. Maintaining hemoglobin levels within the range proposed by guidelines has become a major challenge, with hemoglobin cycling affecting more than 90% of patients undergoing hemodialysis. The variability of hemoglobin levels over time was assessed in our patients. METHODS: Data were retrospectively collected on 249 patients undergoing hemodialysis over a 3-year period at seven centers in Brazil. Hemoglobin was measured at least monthly, and target levels were those between 10.5 g/dL and 12.5 g/dL. Patients were grouped into six categories of variability consistently low (<10.5g/dL), consistently target range (10.5 to 12.5 g/dL), consistently high (>12.5g/dL), low amplitude fluctuation with low hemoglobin levels, low amplitude fluctuation with high hemoglobin levels and high amplitude fluctuation. None of the patients maintained stable hemoglobin levels for the entire 36-month period. RESULTS: The mean monthly proportion of patients that had hemoglobin levels within the target range was 50% (range, 42% to 61%). Mean levels above the target (30%) were more frequent than those below it (20%). During 6, 12, and 36 months, proportions of patients with consistently low levels of hemoglobin decreased from 3.6% to 0%, from 31.7% to 2.8% for those with consistently high, from 7.6% to 0% for those with low amplitude fluctuation with low hemoglobin levels and from 41.3% to 8.3% for those with low amplitude fluctuation with high hemoglobin levels. However, the proportions of patients with high amplitude fluctuation increased from 21.5% to 88.9%. CONCLUSION: Maintaining hemoglobin levels within the target range is difficult, especially for longer periods of time. Missing the target seems more often due to levels above it, but high-amplitude fluctuations eventually occur in the majority of patients.