혈액 투석 환자에서 Recombinant Human Erythropoietin ( rHuEpo ) 치료가 혈중 Lipoprotein ( a ) [ Lp ( a ) ] 를 포함한 지질 농도에 미치는 영향 = Effects of Recombinant Rumen Erythropoietin ( rHuEpo ) on Lipoprotein ( a ) [ Lp ( a ) ] and Other Lipid Profiles in Maintenance Hemodialysis ( HD ) Patients

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다국어 초록 (Multilingual Abstract)

Objectives: The efficacy of rHuEpo in the correction of renal anemia has been well established resulting in theoretical benefits on cardiac function with the regression of left ventricular dilatation. However, hypertension and thrombogenic complications can be developed with rHuEpo therapy, which impose the deleterious effects on cardiovascular system. Moreover there has been no study into the effects of rHuEpo on uremic dyslipidemia which may also contribute to an increased cardiovascular mortality in dialysis patients. Methods: The present prospective study was undertaken to evaluate the effects of rHuEpo on lipid profiles including Lp (a) in 22 (M:F 12:10) maintenance HD patients. rHuEpo was started at a dose of 2000 unit, given subcutaneously two or three times a week, at the end of each dialysis session. Lp (a) and other lipid profiles including total cholesterol (TC), triglyceride (Tg), HDL-cholesterol (HDL-C), and LDL-cholesterol (LDL-C) were measured before treatment, and at two week intervals during the first eight weeks of rHuEpo. Results: Hct started to increase significantly 4 weeks after rHuEpo therapy. The concentrations of TC, Tg and LDL-cholesterol did not significantly change during rHuEpo. The median value of Lp (a) before rHuEpo therapy was 20.4㎎/dl with a distribution from 1.4 to 113.6㎎/dl. Five out of 22 patients (22.7%) had Lp (a) concentrations above 30㎎/dl, which value has been shown to be a high risk for atherosclerosis. The Lp (a) concentration also showed no statistically significant changes in spite of a tendency to decrease with rHuEpo. However, it was interesting that Lp (a) levels in all of the five patients whose Lp (a) was above 30㎎/dl decreased significantly 8 weeks after rHuEpo therapy (58.8±4.5 vs. 32.5±7.9㎎/dl, p<0.05). Conclusions: rHuEpo may decrease the serum Lp (a) level, especially in the high Lp (a) subjects. Although the exact mechanism of this favorable effect on Lp (a) during rHuEpo administration is uncertain, it may contribute to a decrease in cardiovascular morbidity, independent of the effects of anemia correction itself.