Gentil M A, Pérez-Valdivia M A, López-Mendoza M, Ortega F, Arias M, Gómez-Alamillo C, Campistol J M
Hospital Virgen del Rocío, Seville, Spain.
Transplant Proc. 2008 Nov;40(9):2922-4. doi: 10.1016/j.transproceed.2008.08.083.
ARES is a multicenter, prospective study of the prevalence, management, and repercussions on the quality of life of anemia in renal transplant patients with a reduced renal function (creatinine clearance according to Cockcroft-Gault: </=60 and >15 mL/min). The frequency of factor deficiency and its relationship with anemia were analyzed at the baseline time of the study. Of the 500 patients included in the main study, valid data were available for iron metabolism in n = 419 microg/dL; folic acid, n = 205 ng/mL; and vitamin B12, n = 210 pg/mL. Anemia was defined as hemoglobin </=13 g/dL (men) or </=12 g/dL (women) and/or use of erythropoietin (EPO). Anemic patients (59.4%) had less sideremia (73.4 vs 81.2 microg/dL; P = .008), but no significant differences were observed for transferrin saturation index (25.9% vs 25.5%), ferritin (167 vs 171 ng/mL), iron insufficiency (26.5% vs 36.2%), pronounced ferropenia (20.4% vs 20.1%), folic acid (7.5 vs 6.6 ng/mL), or vitamin B12 (486 vs 530 pg/mL). Treatment with oral or intravenous iron was much more frequent in anemic patients (31.6% vs 9.9%; P < .001). The logistic regression analysis of factors associated with anemia revealed that renal function and the use of angiotensin-converting enzyme (ACE) inhibitors were significant but not the degree of iron deficiency. In conclusion, iron deficiency in renal transplant patients with chronic nephropathy is frequent and insufficiently treated. Although it may be an aggravating factor, it was not shown to be a determining factor for the presence or absence of anemia in the patients as a group.
ARES是一项多中心前瞻性研究，旨在探讨肾功能减退（根据Cockcroft - Gault公式计算的肌酐清除率：≤60且>15 mL/分钟）的肾移植患者贫血的患病率、管理及其对生活质量的影响。在研究的基线期分析了因素缺乏的频率及其与贫血的关系。在纳入主要研究的500例患者中，有419例患者可获得有效的铁代谢数据（铁水平为μg/dL）；205例患者可获得叶酸数据（叶酸水平为ng/mL）；210例患者可获得维生素B12数据（维生素B12水平为pg/mL）。贫血定义为血红蛋白≤13 g/dL（男性）或≤12 g/dL（女性）和/或使用促红细胞生成素（EPO）。贫血患者（59.4%）的血清铁水平较低（73.4 vs 81.2 μg/dL；P = 0.008），但转铁蛋白饱和度指数（25.9% vs 25.5%）、铁蛋白（167 vs 171 ng/mL）、铁缺乏（26.5% vs 36.2%）、明显缺铁（20.4% vs 20.1%）、叶酸（7.5 vs 6.6 ng/mL）或维生素B12（486 vs 530 pg/mL）方面未观察到显著差异。贫血患者口服或静脉补铁治疗更为频繁（31.6% vs 9.9%；P < 0.001）。与贫血相关因素的逻辑回归分析显示，肾功能和使用血管紧张素转换酶（ACE）抑制剂具有显著意义，但缺铁程度并非如此。总之，慢性肾病肾移植患者缺铁情况常见且治疗不足。虽然缺铁可能是一个加重因素，但在该组患者中，它并非贫血存在与否的决定性因素。
