Gill Karminder, Fink Jeffrey C, Gilbertson David T, Monda Keri L, Muntner Paul, Lafayette Richard A, Petersen Jeffrey, Chertow Glenn M, Bradbury Brian D
Ascentiant International, Carlsbad, CA, USA.
Department of Medicine, University of Maryland, Baltimore, MD, USA.
Pharmacoepidemiol Drug Saf. 2015 Jun;24(6):654-62. doi: 10.1002/pds.3779. Epub 2015 Apr 22.
In recent years, the use of red blood cell (RBC) transfusion for the treatment of chronic kidney disease (CKD)-related anemia has increased. We used the OptumInsight medical claims database to study the association between receiving a transfusion and hyperkalemia and heart failure events.
Persons 18-64 years of age with diagnosed stage 4 or 5 CKD (not requiring dialysis) between 2006 and 2010 were followed until their first hospitalization or emergency room visit with a diagnosis of hyperkalemia or heart failure, termination of insurance coverage, or death. We used a case-only design and conditional logistic regression to estimate rate ratios (RR) and 95% confidence intervals (CIs) describing associations between RBC transfusion and the risks of hyperkalemia or heart failure. We used single (1:1) and variable (1:m) self-control matching intervals, with adjustment for time-varying confounders.
Seven thousand eight hundred twenty-nine individuals met our inclusion criteria; two-thirds were age 50 years or older; 43% were women and 51% had diabetes. Rates of hyperkalemia and heart failure were 7.9/100 person-years (95%CI: 7.3, 8.5) and 16.3/100 person-years (95%CI: 15.5, 17.2), respectively. RBC transfusion was associated with an increased risk of both hyperkalemia (single interval matched RR = 12.0, 95%CI: 1.3, 109; multiple interval matched RR = 6.1, 95%CI: 2.5, 15.1) and heart failure (single interval matched RR = 1.7, 95%CI: 0.3, 9.2; multiple interval matched RR = 3.8, 95%CI: 1.4, 10.3).
In patients with advanced CKD, RBC transfusion appears to be associated with an elevated risk of hyperkalemia and heart failure; further investigation into these risks is warranted.
近年来，使用红细胞（RBC）输血治疗慢性肾脏病（CKD）相关贫血的情况有所增加。我们利用OptumInsight医疗索赔数据库研究输血与高钾血症及心力衰竭事件之间的关联。
对2006年至2010年间确诊为4期或5期CKD（无需透析）的18至64岁人群进行随访，直至他们首次因高钾血症或心力衰竭诊断而住院或急诊就诊、保险覆盖终止或死亡。我们采用仅病例设计和条件逻辑回归来估计率比（RR）和95%置信区间（CI），以描述RBC输血与高钾血症或心力衰竭风险之间的关联。我们使用单一（1:1）和可变（1:m）自我对照匹配区间，并对随时间变化的混杂因素进行调整。
7829名个体符合我们的纳入标准；三分之二年龄在50岁及以上；43%为女性，51%患有糖尿病。高钾血症和心力衰竭的发生率分别为7.9/100人年（95%CI：7.3，8.5）和16.3/100人年（95%CI：15.5，17.2）。RBC输血与高钾血症（单一区间匹配RR = 12.0，95%CI：1.3，109；多个区间匹配RR = 6.1，95%CI：2.5，15.1）和心力衰竭（单一区间匹配RR = 1.7，95%CI：0.3，9.2；多个区间匹配RR = 3.8，95%CI：1.4，10.3）风险增加均相关。
在晚期CKD患者中，RBC输血似乎与高钾血症和心力衰竭风险升高相关；有必要对这些风险进行进一步研究。
