Przybylowski P, Malyszko J, Malyszko J
Department of Cardiac Surgery and Transplantology, Collegium Medicum, Jagiellonian University, Pradnicka 80, Cracow, Poland.
Transplant Proc. 2009 Oct;41(8):3228-31. doi: 10.1016/j.transproceed.2009.07.076.
Cardiovascular disease and kidney disease share similar characteristics. It has been recently recognized that many patients with cardiovascular disease have anemia, which often is associated with kidney dysfunction. Even the term "cardiorenal anemia syndrome" was endorsed to stress the dangerous association.
To assess the prevalence of anemia in relation to chronic kidney disease in 160 patients after orthotopic heart transplantation.
According to the World Health Organization definition of anemia (hemoglobin concentration <13 g/dL in males and <12 g/dL in females), 41% of our patients had anemia. Patients with anemia exhibited a significantly lower mean (SD) glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease formula vs the Cockcroft-Gault formula: 44.46 (26.84) mL/min vs 62.70 (24.15) mL/min and 48.93 (27.80) mL/min vs 72.11 (29.76) mL/min, respectively (P < .001). In addition, they demonstrated lower creatinine clearance, red blood cell count, hemoglobin concentration, and ejection fraction and significantly higher creatinine and N-terminal probrain natriuretic peptide concentrations. Presence of anemia was associated with time since transplantation, GFR, creatinine clearance, N-terminal probrain natriuretic peptide and cholesterol concentrations, and ejection fraction. At multiple regression analysis, the only predictor of anemia was kidney function (GFR or creatinine clearance), which accounts for 22% of the variation. Type of immunosuppression regimen (calcineurin inhibitors vs mammalian target of rapamycin) did not seem to affect prevalence of anemia in the study population.
The prevalence of anemia is relatively high in heart allograft recipients and is not adequately treated. In patients with cardiovascular disease, GFR should be estimated because renal dysfunction and subsequent anemia are important risk factors for cardiovascular morbidity and mortality. Chronic heart failure is also more common in patients with anemia.
心血管疾病和肾脏疾病具有相似的特征。最近人们认识到，许多心血管疾病患者存在贫血，且往往与肾功能不全有关。甚至“心肾贫血综合征”这一术语也被认可，以强调这种危险的关联。
评估160例原位心脏移植术后患者中与慢性肾脏病相关的贫血患病率。
根据世界卫生组织对贫血的定义（男性血红蛋白浓度<13 g/dL，女性<12 g/dL），我们的患者中有41%患有贫血。与使用Cockcroft-Gault公式相比，使用肾脏病饮食改良公式时，贫血患者的平均（标准差）肾小球滤过率（GFR）显著更低：分别为44.46（26.84）mL/min对62.70（24.15）mL/min以及48.93（27.80）mL/min对72.11（29.76）mL/min（P <.001）。此外，他们的肌酐清除率、红细胞计数、血红蛋白浓度和射血分数更低，而肌酐和N末端脑钠肽前体浓度显著更高。贫血的存在与移植后的时间、GFR、肌酐清除率、N末端脑钠肽前体和胆固醇浓度以及射血分数有关。在多元回归分析中，贫血的唯一预测因素是肾功能（GFR或肌酐清除率），其占变异的22%。免疫抑制方案的类型（钙调神经磷酸酶抑制剂与雷帕霉素靶蛋白）似乎并未影响研究人群中贫血的患病率。
心脏移植受者中贫血患病率相对较高且未得到充分治疗。在心血管疾病患者中，应评估GFR，因为肾功能不全及随后的贫血是心血管发病和死亡的重要危险因素。慢性心力衰竭在贫血患者中也更常见。
