Iimori Soichiro, Naito Shotaro, Noda Yumi, Nishida Hidenori, Kihira Hiromi, Yui Naofumi, Okado Tomokazu, Sasaki Sei, Uchida Shinichi, Rai Tatemitsu
Department of Nephrology, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Nephrology, Nakano General Hospital, Tokyo, Japan.
Nephrology (Carlton). 2015 Sep;20(9):601-8. doi: 10.1111/nep.12493.
To investigate the association between iron deficiency anaemia and mortality risk and assess the changes in anaemia and iron status after primary management by a nephrologist.
In this prospective cohort study, we stratified 951 non-dialysis chronic kidney disease (CKD) G2-G5 patients newly visiting 16 nephrology centres into four groups according to the presence of anaemia with or without iron deficiency. All-cause mortality, cardiovascular (CV)-related mortality, and a change in anaemia and iron status after specialized primary care were the endpoints evaluated.
During a median follow-up time of 19 months, the number of all-cause deaths and CV-related deaths were 56 and 26, respectively. Compared with the control group, the groups with isolated anaemia and iron deficiency anaemia had significantly higher all-cause mortalities (isolated anaemia: hazard ratio (HR), 3.37; 95% confidence intervals (CI), 1.76-6.44; iron deficiency anaemia: HR, 3.11; 95% CI, 1.21-8.01) and CV-related mortalities (isolated anaemia: HR, 3.64; 95% CI, 1.36-9.73; iron deficiency anaemia: HR, 3.86; 95% CI, 1.11-13.41). In the isolated anaemia group, erythropoietin-stimulating agent (ESA) prescriptions significantly increased to approximately 70%. However, in patients with both anaemia and iron deficiency, iron prescriptions only increased to 48.1%.
Iron deficiency anaemia and isolated anaemia were associated with all-cause and CV-related mortality. The absence of relative increase in iron prescriptions suggests that iron deficiency should be accurately assessed and iron supplementation should be appropriately used to manage anaemia in non-dialysis patients with CKD.
探讨缺铁性贫血与死亡风险之间的关联，并评估肾病科医生进行初步治疗后贫血和铁状态的变化。
在这项前瞻性队列研究中，我们将新到16个肾病中心就诊的951例非透析慢性肾脏病（CKD）G2 - G5期患者，根据有无缺铁性贫血分为四组。评估的终点为全因死亡率、心血管（CV）相关死亡率，以及专科初步治疗后贫血和铁状态的变化。
在中位随访时间19个月期间，全因死亡和CV相关死亡人数分别为56例和26例。与对照组相比，单纯贫血组和缺铁性贫血组的全因死亡率（单纯贫血：风险比（HR），3.37；95%置信区间（CI），1.76 - 6.44；缺铁性贫血：HR，3.11；95% CI，1.21 - 8.01）和CV相关死亡率（单纯贫血：HR，3.64；95% CI，1.36 - 9.73；缺铁性贫血：HR，3.86；95% CI，1.11 - 13.41）显著更高。在单纯贫血组中，促红细胞生成素刺激剂（ESA）处方显著增加至约70%。然而，在同时患有贫血和缺铁的患者中，铁剂处方仅增加至48.1%。
缺铁性贫血和单纯贫血与全因及CV相关死亡率相关。铁剂处方相对未增加表明，对于非透析CKD患者，应准确评估缺铁情况并适当使用铁剂补充来治疗贫血。
