Seventy-two MHD patients, diagnosed with renal anemia at the Zhengzhou TCM Hospital (Henan, China) from March, 2014 to March, 2015 were included in the study. The patients conformed to the diagnostic criteria of chronic nephropathy proposed by the Kidney Disease Improving Global Outcomes (http://kdigo.org). Anemia criteria referred to male hemoglobin (Hb) <120 g/l and female Hb <110 g/l and excluded the anemia caused by other diseases, such as iron deficiency anemia, hemorrhagic anemia, aplastic anemia and multiple myeloma.

Inclusion criteria for the present study were: i) age ≥8 and <75 years; ii) conformed to the abovementioned anemia criteria; and iii) first-time treatment, without adverse reactions. Exclusion criteria for the study were: i) patients with secondary hematological diseases, severe heart, liver and other organ dysfunction, severe hypotension; ii) patients with irreformable anemia and requiring blood transfusion; iii) patients with renal transplantation history, severe secondary parathyroid function (iPTH >1,000 pg/l), active ulcerative disease, malignant tumor, active infection, severe malnutrition; and iv) patients with poor compliance.

Approval for the study was obtained from the ethics committee of the Zhengzhou TCM Hospital. Informed consent of patients and families was also obtained. Subsequently, the patients were randomly divided into the control (n=34) and observation (n=38) groups. The control group included 18 men and 16 women, with an age range of 52–73 years, and an average of 63.5±6.7 years; serum creatinine ranged from 436.7 to 698.3 µmol/l, average 546.2±54.5 µmol/l; weight ranged from 58.6 to 72.5 g, average of 63.3±5.8 kg; urea nitrogen ranged from 16.5 to 37.4 mmol/l, average of 24.1±8.2 mmol/l. The observation group included 20 men and 18 women, with an age range of 48–72 years and an average of 64.2±6.9 years; serum creatinine ranged from 443.6 to 721.4 µmol/l, average of 569.8±62.3 µmol/l; weight ranged from 57.3 to 71.6 g, average of 62.9±5.7 kg; urea nitrogen ranged from 17.2 to 35.5 mmol/l, average of 25.3±8.8 mmol/l. Differences of the two groups regarding gender, age, weight, urea nitrogen and serum creatinine levels were not statistically significant (p>0.05).

The patients in the control group were administered with hypodermic injection of 100–150 U/(kg·w) rHuEPO (3SBio, Inc., Shenyang, China). The Hb was regularly monitored, and the dose was reduced by 25–30% if Hb ≥110 g/l. The patients were observed for one month, by continually reducing the dose by 25–30% if Hb ≥110 g/l, and maintained treatment with the minimum dose. The patients in the observation group were administered with rHuEPO+1.0 g t.i.d. p.o. Shengxuening tablets (GYZZ Z20030088, 0.25 g/piece, sodium iron chlorophyllin >0.15 mg/piece; Wuhan United Pharmacy, Wuhan, China). The two groups were assisted by conventional treatments including iron, folic acid, vitamin B12 and L-carnitine.

The dialysis machine used was Dialog+ Dialysis system machine (B. Braun Melsungen AG, Melsungen Germany). Hemodialysis filtration and hemodialysis perfusion was applied on the basis of general dialysis, 2–3 times/week and 4 h per time. The bicarbonate dialysis liquid system, blood flow rate was of 200–250 ml/min, dialysis fluid flow rate was of 500 ml/min, and dialysis fluid temperature was of 36.5°C. Drugs were combined to control blood pressure, blood glucose and electrolyte balance.

After 3 and 6 months, the improvement of anemia of the two groups were compared including Hb, hematocrit (Hct), serum ferritin (SF) and transferrin saturation (TSAT) levels; inflammatory indices, including C-reactive protein (CRP), and superoxide dismutase (SOD) levels; as well as consumption of rHuEPO and improvement of total efficiency.

SPSS 19.0 statistical software (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Data were presented as mean ± standard deviation. Comparison between groups was made using the Student's t-test. Enumeration data were expressed as a percentage. The comparison between groups was made using the χ² test. P<0.05 was considered statistically significant.

Prior to treatment, differences of Hb, Hct, SF and TSAT levels of the two groups were not statistically significant (p>0.05). After 3 months of treatment, Hb, Hct, SF and TSAT levels of the observation group were significantly higher than those of the control group (p<0.05). After 6 months of treatment, the above indices of the observation group were ameliorated while improvement of the control group was not obvious, and the observation group was significantly higher than the control group (p<0.05) (Table I).

Prior to treatment, differences of the CRP and SOD levels of the two groups were not statistically significant (p>0.05). After 3 months of treatment, CRP and SOD levels of the observation group were significantly lower than those of the control group (p<0.05). After 6 months of treatment, the above indices of the observation group further decreased while improvement of the control group was not obvious, and the observation group was significantly lower than the control group (p<0.05) (Table II).

After 6 months, the consumption of rHuEPO in the observation group was significantly less than that of the control group, and the total effective rate was significantly higher than the control group (p<0.05) (Table III).