Resistance index to epoetin alfa and to darbepoetin-alfa in chronic hemodialysis patients: a cohort study
Estudio de dos cohortes de pacientes para evaluar el índice de resistencia a epoetina alfa y a darbepoetin alfa en pacientes en hemodiálisis crónica
Rafael Perez-Garcia Nefrologia H.U. Gregorio Marañon, Patrocinio Rodríguez Benítez Nefrologia H.U. Gregorio Marañon, Rosa Jofre Nefrologia H.U. Grego
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THREE YEARS WORK OUTCOME" "tienePdf" => "en" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "335" "paginaFinal" => "339" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "GESTION INTEGRAL DEL ACCESO VASCULAR POR LOS NEFROLOGOS.RESULTADOS DE TRES AÑOS DE TRABAJO." ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. García-Trío, M. Alonso, J. Saavedra, S. Cigarrán(*), J.M. Lamas" "autores" => array:1 [ 0 => array:1 [ "nombre" => "G. García-Trío, M. Alonso, J. Saavedra, S. Cigarrán(*), J.M. 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Gregorio Marañon, Patrocinio Rodríguez Benítez Nefrologia H.U. Gregorio Marañon, Rosa Jofre Nefrologia H.U. Grego" "autores" => array:1 [ 0 => array:1 [ "nombre" => "Rafael Perez-Garcia Nefrologia H.U. Gregorio Marañon, Patrocinio Rodríguez Benítez Nefrologia H.U. Gregorio Marañon, Rosa Jofre Nefrologia H.U. Grego" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio de dos cohortes de pacientes para evaluar el índice de resistencia a epoetina alfa y a darbepoetin alfa en pacientes en hemodiálisis crónica" ] ] "tienePdf" => false "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec436313" "palabras" => array:1 [ 0 => "darbepoetin alfa; índice de resistencia; eritropoyetina; hemodiálisis; anemia " ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec436314" "palabras" => array:1 [ 0 => "darbepoetin alfa; resistance index; epoetin; hemodialysis; anemia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "The effectiveness of the erythropoietic response can be evaluated using the resistance index (RI) to erythropoietic agents (EA) that measures the relationship between the dose administered and the hemoglobin levels attained. In a hemodialysis population, the RI is associated with several clinical and biochemical parameters, such as albumin levels, C-reactive protein (CRP), body mass index (BMI) and Kt/V. This index therefore reflects an important group of parameters that indicate comorbidities and measures the effectiveness of the treatment received. A substantial proportion of chronic hemodialysis patients show a relative resistance to human recombinant erythropoietin (rHuEPO) and require high doses to reach hemoglobin levels above 11 g/dl. Darbepoetin alfa is a new erythropoietic agent with a longer half-life than rHuEPO and greater biological activity in vivo. Furthermore, it remains at clinically effective plasma levels for much longer than rHuEPO. This study evaluated the effect on RI of switching from epoetin alfa to darbepoetin alfa in hemodialysis patients requiring i.v. rHuEPO at either high ( >10,000 UI/w) or low ( <4 000 ui w doses compared to a control group receiving epoetin alfa unlike the both groups of patients who switched darbepoetin showed reduction in ri and progressive dose required with respect equivalent at treatment conversion requiring high dri week 24 was significant 23 9 lower than eri 0 p <0 01 in the group requiring low doses dri at week 24 was 13 4 lower than eri conversion p both control groups higher 0 all showed stable hemoglobin levels across study with mean between 11 5 and 3 g dl crp significantly related to albumin <0 001 in conclusion switching hemodialysis patients from epoetin alfa to darbepoetin was associated with a significant improvement ri the group of high doses ea which we consider be an important indicator effectiveness and quality treatment administered</0> </0> </4>" ] "es" => array:1 [ "resumen" => "La efectividad de la respuesta en la estimulación eritropoyética se puede expresar por el índice de resistencia (IR) a los agentes estimuladores de la eritropoyesis, que expresa la relación entre la dosis administrada del agente y las concentraciones de hemoglobina mantenidas. El IR de una población en hemodiálisis se relaciona con una serie de parámetros clínicos y bioquímicos de la hemodiálisis, como la concentración de albúmina, la proteína C reactiva (PCR), el índice de la masa corporal (IMC) y el Kt/V y se presenta, por tanto, como un índice de valoración de un conjunto muy importante de parámetros que expresan la patología comórbida de los pacientes y la calidad del tratamiento recibido. Una proporción considerable de pacientes en hemodiálisis crónica presentan una resistencia relativa o respuesta subóptima a la eritropoyetina recombinante humana (rHuEPO), por lo que precisan dosis elevadas de esta proteína para alcanzar unas concentraciones de hemoglobina superiores a los 11 g/dl. Darbepoetin alfa es una nueva proteína estimuladora de la eritropoyesis con un perfil farmacocinético caracterizado por una semivida mucho más prolongada que la de rHuEPO y una mayor actividad biológica in vivo, permaneciendo mucho más tiempo en plasma a concentraciones clínicamente eficaces en comparación con rHuEPO. El presente estudio evalúa el resultado de cambiar la administración de epoetina alfa a darbepoetin alfa sobre la efectividad y la calidad del tratamiento, determinadas mediante el IR, en pacientes en hemodiálisis que requieren un tratamiento a dosis altas ( >10.000 UI/sem) o bajas ( <4000 ui sem de epoetina alfa por vía i v en comparación con un grupo control que siguió recibiendo los dos grupos pacientes cambiaron a darbepoetin se registró una disminución del ir y la dosis necesaria relación equivalente el momento conversión no fue observada precisó altas ird al final estudio semana 24 disminuyó 23 9 respecto ire 0 estadísticamente significativa p <0 01 de forma similar en el grupo tratado con dosis bajas que cambió a darbepoetin alfa se registró una disminución del ird al final estudio 13 4 respecto ire momento la conversión p ambos grupos control aumentó inicial las concentraciones hemoglobina mantuvieron estables todos los lo largo todo período seguimiento unos valores medios oscilaron entre 11 5 y 3 g dl pcr semana 24 mostraron relación significativa albúmina <0 001 en conclusión la conversión de epoetina alfa a darbepoetin pacientes hemodiálisis tuvo como resultado una mejoría significativa del ir al tratamiento los con mayores necesidades aee</0> </0> </4000>" ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000002700000003/v0_201502091552/X2013251407021339/v0_201502091552/en/main.assets" "Apartado" => null "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251407021339?idApp=UINPBA000064" ]
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ISSN: 20132514Original language: English
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