Chonchol Michel, Lippi Giuseppe, Montagnana Martina, Muggeo Michele, Targher Giovanni
University of Colorado Health Sciences Center, Division of Renal Diseases and Hypertension, Box C-281, Denver, CO 80262, USA.
Nephrol Dial Transplant. 2008 Sep;23(9):2879-83. doi: 10.1093/ndt/gfn109. Epub 2008 Mar 7.
Anaemia associated with chronic kidney disease (CKD) has substantial public health importance. However, the association of haemoglobin concentrations with inflammation in the setting of decreased kidney function is not well established.
We analysed cross-sectional data from 7389 outpatient adults, who were referred by general practitioners for routine blood testing between June 2006 and June 2007. Glomerular filtration rate (eGFR) was estimated by the abbreviated Modification of Diet in Renal Disease (MDRD) equation. Multivariable linear regression analysis was used to identify factors independently associated with haemoglobin concentrations across eGFR categories as the main outcome.
Of the 7389 participants included in the analytic cohort 2221 (30.1%) participants had eGFR >/=90 mL/min/m(2), 4310 (58.3%) 60-89 mL/min/m(2) and 858 (11.6%) <60 mL/min/m(2). There were significant, graded, increases in high sensitivity C-reactive protein (hs-CRP) and haemoglobin concentrations across eGFR categories independent of age, gender, plasma glucose and lipids (P < 0.0001 for trends). In the multivariable regression analysis, increased hs-CRP concentrations were independently associated with lower haemoglobin concentrations at different stages of eGFR (P < 0.0001 for all). Other independent predictors of lower haemoglobin were older age, female gender and lower eGFR.
Our findings suggest that increased plasma hs-CRP concentrations are independently associated with anaemia in the setting of decreased kidney function in a large cohort of unselected adult outpatients.
与慢性肾脏病（CKD）相关的贫血具有重大的公共卫生意义。然而，在肾功能下降的情况下，血红蛋白浓度与炎症之间的关联尚未明确确立。
我们分析了2006年6月至2007年6月期间由全科医生转诊进行常规血液检测的7389名门诊成年患者的横断面数据。采用简化的肾脏病饮食改良（MDRD）方程估算肾小球滤过率（eGFR）。多变量线性回归分析用于确定与不同eGFR类别血红蛋白浓度独立相关的因素作为主要结局。
在纳入分析队列的7389名参与者中，2221名（30.1%）参与者的eGFR≥90 mL/min/m²，4310名（58.3%）为60 - 89 mL/min/m²，858名（11.6%）<60 mL/min/m²。在不考虑年龄、性别、血糖和血脂的情况下，不同eGFR类别中高敏C反应蛋白（hs-CRP）和血红蛋白浓度均有显著的分级增加（趋势P<0.0001）。在多变量回归分析中，hs-CRP浓度升高与不同eGFR阶段的较低血红蛋白浓度独立相关（所有P<0.0001）。血红蛋白降低的其他独立预测因素为年龄较大、女性性别和较低的eGFR。
我们的研究结果表明，在一大群未经选择的成年门诊患者中，血浆hs-CRP浓度升高与肾功能下降情况下的贫血独立相关。
