Mohanram A, Zhang Z, Shahinfar S, Lyle P A, Toto R D
Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
Kidney Int. 2008 Mar;73(5):630-6. doi: 10.1038/sj.ki.5002746. Epub 2007 Dec 19.
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can decrease hemoglobin, causing anemia and this may be an independent risk factor for chronic kidney disease progression. We studied the relationship between a decline in hemoglobin and outcome in 1513 patients with type 2 diabetes and kidney disease by a post hoc analysis of the RENAAL Study (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan) with an average follow-up of 3.4 years. The relationship between baseline and year-1 hemoglobin and treatment on end-stage renal disease (ESRD) and ESRD or death was evaluated using multivariate Cox models (covariates: baseline hemoglobin, proteinuria, serum albumin, serum creatinine, and year-1 hemoglobin). Compared with placebo, losartan treatment was associated with a significant decrease of hemoglobin, with the largest between-group difference at 1 year. After adjustment, there were significant relative risk reductions for losartan compared with placebo for ESRD and for ESRD or death regardless of the baseline hemoglobin even in those patients with a baseline hemoglobin below 120 g l(-1). Hence, the renoprotective properties of losartan were maintained despite a significant lowering of the hemoglobin concentration.
血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂可降低血红蛋白水平，导致贫血，这可能是慢性肾脏病进展的一个独立危险因素。我们通过对RENAAL研究（用血管紧张素II拮抗剂氯沙坦降低非胰岛素依赖型糖尿病终点事件）进行事后分析，研究了1513例2型糖尿病肾病患者血红蛋白下降与预后之间的关系，平均随访时间为3.4年。使用多变量Cox模型（协变量：基线血红蛋白、蛋白尿、血清白蛋白、血清肌酐和第1年血红蛋白）评估基线和第1年血红蛋白以及治疗对终末期肾病（ESRD）和ESRD或死亡的影响。与安慰剂相比，氯沙坦治疗与血红蛋白显著降低相关，组间差异在1年时最大。调整后，无论基线血红蛋白如何，即使是基线血红蛋白低于120 g l(-1)的患者，氯沙坦与安慰剂相比，ESRD以及ESRD或死亡的相对风险均显著降低。因此，尽管血红蛋白浓度显著降低，但氯沙坦的肾脏保护作用依然存在。
