hemodialysis peritoneal dialysis

1
Hemoglobin levels of hemodialytic patients
comparisons to peritoneal dialytic patients
in 1 year after start dialysis


(background and rationale)
(Chronic kidney disease)



(1,2)


(background and rationale)
(anemia)
(chronic kidney disease)
(Hemoglobin) 11
25 50
4 5



(Left ventricular hypertrophy)
(3,4)


(background and rationale)



The national kidney foundation 2006
GFR 15
(renal transplantation therapy) 3
(Peritoneal dialysis ; PD)
(Hemodialysis ; HD) (Kidney transplantation)


(background and rationale)





(anemia) HD
PD (5,6)
preserve residual renal function
(modalities) uremia toxin
(7)


(background and rationale)

(Hemoglobin)


(background and rationale)



(hemodialysis)
(continuous ambulatory peritoneal dialysis)
0, 3, 6, 9, 12



(hemodialysis)
(continuous ambulatory peritoneal dialysis) 0, 3, 6, 9, 12


1.) Hemodialysis Peritoneal
dialysis Hb level 0, 3, 6, 9, 12
dialysis

2.)
-
- Dialysis modality 1 dialysis

3.)
- Acute Renal injury
- Acute on top chronic kidney disease


(Chronic kidney disease) : ,
GFR, ,

Hemodialysis
Peritoneal Dialysis
Erythropoietin

 (Chronic kidney disease)

(CKD) 3
2
1.
GFR 60 .//1.73 2 3
2. 3
GFR
a)
b)

microalbuminemia* (
> 30 ./. Creatinine)

* 2 random urine

 GFR
creatinine
serum creatinine(S.cr)
S.cr
cr cr
GFR
1. Ccr 24 .
2. Ccr S.cr Cockcroft & Gaults formula
3. estimated GFR (eGFR) S.cr

a) MDRD-GFR equation
b) Re-expressed MDRD-GFR equation
c) CKD-EPI equation

 eGFR(Thai)
..
eGFR
eGFR(Thai) = 175 x S.crENZ-1.154 x Age-0.203 x (0.742 ) x (1.129 )

racial conversion factor eGFR

1.129 Re-expressed MDRD Equation-GFR
equation


1 GFR 1-5

1**
2**
3#
4#
5#

GFR
GFR
GFR
GFR

GFR*

++ (%)

(ml/min/1.73 m2)

Thai SEEK Study, 2007

90
60-89
30-59
15-29
<15

3.3
5.6
7.5
0.8
0.3

* GFR MDRD-eGFR equation

** microalbuminuria proteinuria
# CKD 3-5 microalbuminuria proteinuria
GFR 60 .//1.73 2
++

1-5 17.5 7
0.3 1

(16.3% vs. 18.7%)

3
<40 1 10
40-59 1 6
60-69 1 3
70 1 2

 :
(renal
replacement therapy; RRT)
..2553 dialyisis 32,132

84% (hemodialysis)
/ 2-3 //
6,400 9,600 /






GFR (CKD stage 4-5)


HD PD
2
(Hemodialysis; HD)


2-3 4-5
(Peritoneal Dialysis; PD)


4 4-6
continuous ambulatory peritoneal dialysis (CAPD)


RRT

1.
2.
3. (chronic glomerulonephritis)
4. (polycystic kidney disease)
5.
,
renal tubular acidosis(RTA), ,
Aristolochic acid


(CKD progression)
35
GFR -1 .//1.73 2 /

1.
6.
2. proteinuria 7. acute kidney
3.
injury

8.
4.
9.
10.
NSAIDs, radio contrast
5. hyperphosphatemia
vascular
calcification


Erythropoietin

Hemoglobin Levels and Erythropoietin Doses in
Hemodialysis and Peritoneal Dialysis Patients
in the United States
JON J. SNYDER,* ROBERT N. FOLEY,* DAVID T. GILBERTSON,*
EDWARD F. VONESH, and ALLAN J. COLLINS*

*Nephrology Analytical Services, Minneapolis Medical

Research Foundation, Minneapolis, Minnesota; and Applied
Statistics Center, Baxter Healthcare Corporation, Round Lake,
Illinois


Erythropoietin


retrospective study hemoglobin
levels erythropoietin ESRD
hemodialysis peritoneal dialysis

:
1. erythropoietin 1 dialysis
2. erythropoietin doses 1 erythropoietin
3. hemoglobin levels 1 erythropoietin


hemodialysis 121,970
peritoneal dialysis 7,129
1995 2000
65
erythropoietin dialysis
dialysis 6
dialysis
erythropoietin
hemoglobin


erythropoietin
erythropoietin hemoglobin
3
25% peritoneal dialysis
80% hemodialysis
erythropoietin doses
30,000 units peritoneal dialysis 60,000
units hemodialysis
hemoglobin levels
hemoglobin target level 11-12 g/dl.
erythropoietin doses



Management of anemia in haemodialysis and peritoneal dialysis
patients (Chapter 8)
Donald Richardson, Alex Hodsman, Dirk van Schalkwyk, Charlie Tomson and
Graham Warwick
NephrolDialTransplant(2007)22[Suppl7]:vii78vii104




Donald

hemodialysis peritoneal dialysis
dialysis
Hb Ferritin

41% UK RRT Renal Replacement Therapy
Hb < 10.0 g/dl. Hb 10.3
g/dl




Hb UK hemodialysis 11.8 g/dl IQR
10.7-12.8 g/dl 86% Hb >= 10.0 g/dl
Hb UK Peritoneal dialysis 12 g/dl IQR
11.0-12.9 g/dl 90% Hb >=10.0 g/dl
Ferritin hemodialysis = 413 g/l (IQR 262-623)
95% ferritin >= 100 g/l




Ferritin Peritoneal dialysis = 256 g/l (IQR 147421) 86% Ferritin >=100 g/l
HD ESA (Erythropoiesis Stimulating Agents)
PD (88% vs 76%) HD dose ESA
PD (9204 vs 6080 IU/week)

Dialysis Hb 10.512.5 g/dl

HD Dose ESA treatment PD
PD ESA
Dialysis
Hb
Dose ESA ESA
erythropoetic response


Patient Group

Hb (g/dL) 6 m

LOW*

<11

TARGET

11-12

HIGH

>12

10

( 6.5

LOW, LAL HA

LAL*

11

LAH

12

HA*

<11 11-12
>12

90


(operational definition)

- Hemodialysis
Peritoneal dialysis . .
3 1 ( )
- Hemodialysis
- Peritoneal dialysis
-(Chronic kidney disease,Chronic renal failure)
- Chronic kidney disease

-GFR(Glomerular filtration rate) 1

creatinine

Cockcroft-Gault equation.
creatinine crearance(GFR)(ml/min)= (140 ( )) x () /
( creatinine(mg/dl) x 72)
(0.85 )
- Hb 10 g/dl
Hct 30 %

-Hb hemoglobin g/dl

-Hct
-Erythropoietin (EPO)

EPO Unit/kg


chronic kidney disease
chronic renal failure
end stage renal disease
ESRD
Anemia
Hemoglobin
Hematocrit
erythropoietin
EPO
Hemodialysis
HD
peritoneal Dialysis
PD
renal replacement therapy



() .

Hemodialysis
Peritoneal dialysis . .
3 1 ( )

 (Data analysis)




(Dialysis)
;

; (eGFR)

0, 3, 6, 9, 12



Z
0, 3, 6, 9, 12


0.05
SPSS for Windows
Release 9.01

1,000
200
300
1,000
200

2,700

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