Levin Adeera, Djurdjev Ognjenka, Duncan John, Rosenbaum Debbie, Werb Ron
Division of Nephrology, University of British Columbia, 1081 Burrard Street, Rm 6010A, Vancouver BC Canada V6Z1Y8.
Nephrol Dial Transplant. 2006 Feb;21(2):370-7. doi: 10.1093/ndt/gfi209. Epub 2005 Oct 25.
Haemoglobin (Hgb) levels are known to be associated with numerous adverse outcomes in both chronic kidney disease (CKD) and non-CKD patients. This analysis evaluates the association of baseline haemoglobin levels on survival in CKD patients, who are followed by nephrologists, irrespective of glomerular filtration rate (GFR), prior to initiation of renal replacement therapy (RRT) and erythropoietin hormone replacement therapy. Analysis of data from the provincial database (PROMIS, Patient Registration and Outcome Management Information System) in British Columbia, Canada, was undertaken. Records used for the analysis included all CKD patients at first registration: GFR <60 ml/min/1.73 m(2), not yet on dialysis, starting from May 1998 to October 2002, and who had complete data (defined as age and gender, diabetic status, eGFR and Hgb levels). The primary objective of this study was to determine the association of Hgb and survival controlling for eGFR at first registration value, age, gender and diabetic status. Multivariate Cox proportional hazards analysis with time to death as outcome variable was performed. The cohort included 3028 patients: the mean age was 65 years, 28% were diabetic, and the mean eGFR in the cohort was 21 ml/min/1.73 m(2). The cohort is representative of the BC CKD and dialysis population regarding ethnicity: 64% Caucasian, 32% Asian. Median follow-up was 27 months, 1 year survival was 0.92, 2 year survival was 0.85. Hgb at initial registration is a statistically independent predictor of survival (RR = 0.875 for every 10 g/l, 95% CI: 0.835-0.917, P = 0.0001), after adjusting for age, gender, diabetic status and baseline eGFR. Further analysis, controlling for RRT, demonstrated a similar association between Hgb and survival (RR = 0.853 for every 10 g/l, 95% CI: 0.799-0.910, P = 0.0001), after adjusting for above variables. Substantial variation in Hgb values exists at all GFR levels. These findings underscore the importance of evaluating Hgb at all GFR levels, and the need to study the impact of modification of Hgb at different GFR levels on survival.
已知血红蛋白（Hgb）水平与慢性肾脏病（CKD）患者和非CKD患者的众多不良结局相关。本分析评估了基线血红蛋白水平与CKD患者生存情况的关联，这些患者由肾病科医生随访，在开始肾脏替代治疗（RRT）和促红细胞生成素激素替代治疗之前，无论其肾小球滤过率（GFR）如何。对加拿大不列颠哥伦比亚省省级数据库（PROMIS，患者登记和结局管理信息系统）的数据进行了分析。用于分析的记录包括首次登记时的所有CKD患者：GFR<60 ml/min/1.73 m²，尚未接受透析，从1998年5月至2002年10月，且有完整数据（定义为年龄、性别、糖尿病状态、估算肾小球滤过率[eGFR]和血红蛋白水平）。本研究的主要目的是确定在控制首次登记时的eGFR、年龄、性别和糖尿病状态的情况下，血红蛋白与生存情况的关联。以死亡时间作为结局变量进行了多变量Cox比例风险分析。该队列包括3028名患者：平均年龄为65岁，28%为糖尿病患者，队列中的平均eGFR为21 ml/min/1.73 m²。就种族而言，该队列代表了不列颠哥伦比亚省的CKD和透析人群：64%为白种人，32%为亚洲人。中位随访时间为27个月，1年生存率为0.92，2年生存率为0.85。在调整年龄、性别、糖尿病状态和基线eGFR后，首次登记时的血红蛋白是生存情况的统计学独立预测因素（每10 g/l的风险比[RR]=0.875，95%置信区间[CI]：0.835 - 0.917，P = 0.0001）。在控制RRT的进一步分析中，调整上述变量后，血红蛋白与生存情况之间显示出类似的关联（每10 g/l的RR = 0.853，95% CI：0.799 - 0.910，P = 0.0001）。在所有GFR水平上，血红蛋白值都存在显著差异。这些发现强调了在所有GFR水平评估血红蛋白的重要性，以及研究不同GFR水平下血红蛋白调整对生存情况影响的必要性。
