Department of Nephrology and Transplantology, Medical University, Bialystok, Poland.
Arch Med Sci. 2010 Aug 30;6(4):539-44. doi: 10.5114/aoms.2010.14465. Epub 2010 Sep 7.
Anaemia is one of the arms of the cardio-renal-anaemia syndrome (CRA) in chronic kidney disease (CKD) patients. The correction of anaemia was effective in the amelioration of both cardiac and renal failure. We studied the relationship between the severity of CRA syndrome in peritoneally dialyzed patients and their survival probability.
Fifty-six patients on peritoneal dialysis were followed for 1 year. Definition of the severity of the CRA in dialysis patients: cardiac arm - NYHA class I-IV = 1-4 points, renal arm - non-diabetic patients age < 65 =1 point, non-diabetic patients age>65 = 2 points, diabetic patients age < 65 = 3 points, diabetic patients age>65 = 4 points, anaemia arm - Hb 11-13 g/dl (male), 11-12 g/dl (female) = 1 point, Hb 10-11 g/dl = 2 points, Hb 9-10 g/dl = 3 points, Hb < 9 g/dl = 4 points. The severity score = cardiac + renal + anaemia arms score divided by 3 (maximum 4 points).
A total of 10/56 patients (18%) died during the study. The median value for the severity score of the whole group was 1.69. In Kaplan-Meier analysis CRA severity score was strongly associated with mortality (p < 0.001). It also correlated with albumin, CRP, erythropoietin treatment, Hb and fasting glucose. In the multivariate regression analysis age, Hb, albumin, and presence of diabetes remained significant predictors of death.
The severity score of CRA syndrome in peritoneally dialyzed patients is an independent and very significant predictor of death. The patients with a high severity score had more hypoalbuminaemia, higher inflammation markers and higher prevalence of diabetes and chronic heart failure. Cardio-renal-anaemia syndrome severity scoring as defined by us could be an easy tool to predict outcome of dialysis patients.
贫血是慢性肾脏病（CKD）患者心肾贫血综合征（CRA）的一个分支。贫血的纠正对于改善心脏和肾脏衰竭均有效。我们研究了腹膜透析患者中 CRA 综合征的严重程度与他们的生存概率之间的关系。
对 56 名接受腹膜透析的患者进行了为期 1 年的随访。定义透析患者 CRA 严重程度：心脏臂-NYHA 分级 I-IV=1-4 分，肾脏臂-非糖尿病患者年龄<65=1 分，非糖尿病患者年龄>65=2 分，糖尿病患者年龄<65=3 分，糖尿病患者年龄>65=4 分，贫血臂-Hb11-13g/dl（男性），11-12g/dl（女性）=1 分，Hb10-11g/dl=2 分，Hb9-10g/dl=3 分，Hb<9g/dl=4 分。严重程度评分=心脏+肾脏+贫血臂评分除以 3（最高 4 分）。
在研究期间，共有 10/56 名患者（18%）死亡。整个组的严重程度评分中位数为 1.69。在 Kaplan-Meier 分析中，CRA 严重程度评分与死亡率密切相关（p<0.001）。它还与白蛋白、CRP、促红细胞生成素治疗、Hb 和空腹血糖相关。在多变量回归分析中，年龄、Hb、白蛋白和糖尿病的存在仍然是死亡的显著预测因素。
腹膜透析患者 CRA 综合征的严重程度评分是死亡的独立且非常重要的预测因素。严重程度评分较高的患者白蛋白水平较低、炎症标志物水平较高、糖尿病和慢性心力衰竭的患病率较高。我们定义的 CRA 综合征严重程度评分可能是预测透析患者预后的一种简单工具。
