Thorp Micah L, Johnson Eric S, Yang Xuihai, Petrik Amanda F, Platt Robert, Smith David H
Department of Nephrology, The Kaiser Permanente Northwest, Portland, Oregano 97227, USA.
Nephrology (Carlton). 2009 Apr;14(2):240-6. doi: 10.1111/j.1440-1797.2008.01065.x.
To determine whether an independent association exists between anaemia and chronic kidney disease (CKD) outcomes in a quasi-incidence cohort when patients' most recent laboratory values are considered.
We conducted a dynamic, retrospective cohort study among patients with incident CKD in a large health maintenance organization administrative data set. CKD was defined by two estimated glomerular filtration rates (eGFR). We measured the absolute rates for all-cause mortality, cardiovascular hospitalizations and end-stage renal disease.
Our completed cases Cox regression model followed 5885 patients with both CKD and haemoglobin measures. For patients with the most severe anaemia (haemoglobin <10.5 g/dL), we estimated an increased rate of mortality (hazard ratio (HR)=5.27, CI 4.37-6.35), cardiovascular hospitalizations (HR=2.18, CI 1.76-2.70) and end-stage renal disease (HR=5.46, CI 3.38-8.82) when compared with patients who were not anaemic; the HR reflect time-varying haemoglobins and eGFR.
Anaemia is a predictor of excess mortality, excess cardiovascular hospitalizations and excess end-stage renal disease even when the progression of CKD is considered by controlling for time-varying eGFR values.
在一个准发病率队列中，当考虑患者最近的实验室检查值时，确定贫血与慢性肾脏病（CKD）预后之间是否存在独立关联。
我们在一个大型健康维护组织的管理数据集中，对新发CKD患者进行了一项动态回顾性队列研究。CKD由两个估算肾小球滤过率（eGFR）定义。我们测量了全因死亡率、心血管疾病住院率和终末期肾病的绝对发生率。
我们的完整病例Cox回归模型纳入了5885例同时有CKD和血红蛋白测量值的患者。对于贫血最严重的患者（血红蛋白<10.5 g/dL），与非贫血患者相比，我们估计其死亡率（风险比（HR）=5.27，95%置信区间4.37 - 6.35）、心血管疾病住院率（HR=2.18，95%置信区间1.76 - 2.70）和终末期肾病发生率（HR=5.46，95%置信区间3.38 - 8.82）均升高；该HR反映了随时间变化的血红蛋白和eGFR。
即使通过控制随时间变化的eGFR值来考虑CKD的进展情况，贫血仍是死亡率增加、心血管疾病住院率增加和终末期肾病增加的一个预测因素。
