Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Nephron Clin Pract. 2010;115(2):c133-41. doi: 10.1159/000312876. Epub 2010 Apr 22.
BACKGROUND/AIM: Anemia is associated with increased mortality and morbidity in both early and very late stages of chronic kidney disease (CKD). The aim of this study was to assess whether anemia is a risk factor for mortality or hospitalization in CKD stage 4-5 predialysis patients not yet on dialysis.
Incident predialysis patients were included between 1999 and 2001 and followed until January 2008 or death. Anemia was defined as mean hemoglobin (Hb) < or =11 g/dl in the 3 months before the start of predialysis. Associations were assessed by Cox regression, linear and logistic regression analysis.
A total of 472 patients were included (median follow-up time 12 months, 11% died, 79% started dialysis). Mean Hb was 11.2 g/dl (minimum 7.6, maximum 16.9). Forty-eight percent of patients had anemia at the start of predialysis care. The adjusted mortality risk (hazard ratio, 95% confidence interval) for anemic compared to nonanemic patients was 1.92 (1.04, 3.52). Anemia tended to be related to all-cause but not to non-dialysis-related hospitalization risk.
At the start of predialysis care, 48% of patients had anemia. Anemia as defined in guideline targets is not associated with an increase in hospitalizations not related to renal replacement therapy, but is likely an important risk factor for mortality in predialysis patients.
背景/目的：贫血与慢性肾脏病（CKD）早期和晚期的死亡率和发病率增加有关。本研究的目的是评估在尚未接受透析的 CKD 4-5 期透析前患者中，贫血是否是死亡或住院的危险因素。
1999 年至 2001 年间纳入了首发透析前患者，并随访至 2008 年 1 月或死亡。贫血定义为透析前 3 个月内平均血红蛋白（Hb）<或=11g/dl。通过 Cox 回归、线性和逻辑回归分析评估相关性。
共纳入 472 例患者（中位随访时间 12 个月，11%死亡，79%开始透析）。平均 Hb 为 11.2g/dl（最低 7.6，最高 16.9）。48%的患者在开始透析治疗时存在贫血。与非贫血患者相比，贫血患者的调整死亡率风险（危险比，95%置信区间）为 1.92（1.04，3.52）。贫血与全因但与非透析相关的住院风险相关。
在开始透析治疗时，48%的患者存在贫血。指南目标中定义的贫血与非肾脏替代治疗相关的住院风险增加无关，但可能是透析前患者死亡的重要危险因素。
