Astor Brad C, Coresh Josef, Heiss Gerardo, Pettitt Dan, Sarnak Mark J
Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Am Heart J. 2006 Feb;151(2):492-500. doi: 10.1016/j.ahj.2005.03.055.
Kidney failure causes anemia and is associated with a very high risk of coronary heart disease (CHD). Mildly to moderately decreased kidney function is far more common and also is associated with an elevated prevalence of anemia and CHD risk. Recent data suggest an even higher risk of CHD when both conditions are present.
We investigated the association of kidney dysfunction and anemia with CHD events (fatal or nonfatal CHD or coronary revascularization procedures) and CHD and all-cause mortality over 12 years of follow-up in 14971 adults aged 45 to 64 years in the ARIC Study. Glomerular filtration rate (GFR) was estimated from calibrated serum creatinine using the MDRD Study equation (< 30 mL/min per 1.73 m2 excluded, n = 32). Anemia was defined as hemoglobin level < 13.5 g/dL in men (648/6746, 9.6%) and < 12 g/dL in women (1049/8225, 12.8%).
The prevalence of anemia was progressively higher at lower estimated GFR < 75 mL/min per 1.73 m2 (both P < .001) for both men and women. A total of 1635 (10.9%) participants had a CHD event, 360 (2.4%) died of CHD, and 1722 (11.5%) died of any cause during follow-up. After adjustment for known risk factors, including diabetes, lipid levels, blood pressure, and use of antihypertensive medication, decreased kidney function was associated with a higher risk of recurrent CHD events and mortality from CHD and all causes. These associations were significantly stronger among participants with anemia. The adjusted relative hazards of all-cause mortality associated with moderately decreased versus normal kidney function (GFR 30-59 vs > or = 90 mL/min per 1.73 m2) were 1.7 (95% CI 1.3-2.2) in the absence of anemia and 3.5 (95% CI 2.4-5.1) in the presence of anemia (P interaction = .001).
The combination of moderately decreased kidney function and anemia is associated with an increased risk of CHD events and mortality, emphasizing the need to identify individuals with these conditions and evaluate interventions to treat anemia and slow the progression of chronic kidney disease.
肾衰竭会导致贫血，并与冠心病（CHD）的极高风险相关。轻度至中度肾功能下降更为常见，也与贫血患病率升高和冠心病风险增加有关。近期数据表明，当这两种情况同时存在时，冠心病风险甚至更高。
在动脉粥样硬化风险社区（ARIC）研究中，我们对14971名年龄在45至64岁的成年人进行了为期12年的随访，调查了肾功能不全和贫血与冠心病事件（致命或非致命性冠心病或冠状动脉血运重建术）以及冠心病和全因死亡率之间的关联。使用肾脏疾病饮食改良（MDRD）研究方程根据校准的血清肌酐估算肾小球滤过率（GFR）（排除<30 mL/分钟/1.73 m²，n = 32）。贫血定义为男性血红蛋白水平<13.5 g/dL（648/6746，9.6%），女性血红蛋白水平<12 g/dL（1049/8225，12.8%）。
对于男性和女性，在估算的GFR<75 mL/分钟/1.73 m²时，贫血患病率逐渐升高（两者P<0.001）。共有1635名（10.9%）参与者发生了冠心病事件，360名（2.4%）死于冠心病，1722名（11.5%）在随访期间死于任何原因。在对已知风险因素进行调整后，包括糖尿病、血脂水平、血压和使用抗高血压药物，肾功能下降与冠心病复发事件以及冠心病和全因死亡率的较高风险相关。在贫血参与者中，这些关联明显更强。在无贫血情况下，与中度肾功能下降（GFR 30 - 59 vs≥90 mL/分钟/1.73 m²）相比，全因死亡率的调整后相对风险为1.7（95%CI 1.3 - 2.2），在有贫血情况下为3.5（95%CI 2.4 - 5.1）（P交互作用 = 0.001）。
中度肾功能下降和贫血同时存在与冠心病事件和死亡率风险增加相关，强调需要识别患有这些情况的个体，并评估治疗贫血和减缓慢性肾病进展的干预措施。
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