Yamamoto Tae, Miyazaki Mariko, Nakayama Masaaki, Yamada Gen, Matsushima Masato, Sato Mistuhiro, Sato Toshinobu, Taguma Yoshio, Sato Hiroshi, Ito Sadayoshi
Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Center for Advanced Integrated Renal Science, Tohoku University Graduate School of Medicine, Sendai, Japan.
Clin Exp Nephrol. 2016 Aug;20(4):595-602. doi: 10.1007/s10157-015-1190-3. Epub 2015 Oct 30.
Anemia greatly affects the development of renal and cardiovascular outcomes in chronic kidney disease (CKD) patients. However, the impact based on CKD stage remains unclear.
We prospectively followed 2,602 Japanese CKD patients under the care of nephrologists. CKD was defined according to cause, estimated glomerular filtration rate <60 mL/min, and/or proteinuria. Patient outcomes [primary end-points: cardiovascular events (CVEs), all-cause mortality, and end-stage kidney disease (ESKD) requiring renal replacement therapy] were assessed in association with basal hemoglobin (Hb) levels (<10, 10-12 and ≥12 g/dL), stratified by CKD stages.
During follow-up, 123 patients developed CVEs, 41 died, and 220 progressed to ESKD. For stages G3, G4 and G5, ESKD frequencies were 2.8, 64.4, and 544.8 person-years, while CVEs and death were 25.6, 45.6, and 76.3 person-years, respectively. The combined endpoint rate was significantly higher in patients with Hb <10 versus Hb 10-12 g/dL, but a higher risk for CVEs and death with Hb <10 g/dL was found only in G3 [hazard ratio (HR) 4.49, (95 % confidence interval (95 % CI) 2.06-9.80)]. In contrast, risk for ESKD with Hb <10 g/dL was found only in G4 [HR 3.08 (95 % CI 1.40-6.79)] and G5 [HR 1.43 (95 % CI 1.01-2.05)]. No increased risks with higher Hb levels were found.
The impact of renal anemia of Hb <10 g/dL on clinical outcomes differed by CKD stage, with a significantly high risk for CVEs and all-cause mortality in G3 and progression to ESKD in G4 and G5.
贫血对慢性肾脏病（CKD）患者的肾脏及心血管结局的发展有重大影响。然而，基于CKD分期的影响仍不明确。
我们对2602名在肾脏病专家照料下的日本CKD患者进行了前瞻性随访。CKD根据病因、估计肾小球滤过率<60 mL/分钟和/或蛋白尿来定义。根据基础血红蛋白（Hb）水平（<10、10 - 12和≥12 g/dL）对患者结局[主要终点：心血管事件（CVE）、全因死亡率和需要肾脏替代治疗的终末期肾病（ESKD）]进行评估，并按CKD分期分层。
在随访期间，123名患者发生了CVE，41人死亡，220人进展为ESKD。对于G3、G4和G5期，ESKD的发生率分别为2.8、64.4和544.8人年，而CVE和死亡的发生率分别为25.6、45.6和76.3人年。Hb<10 g/dL的患者的联合终点发生率显著高于Hb为10 - 12 g/dL的患者，但仅在G3期发现Hb<10 g/dL的患者发生CVE和死亡的风险更高[风险比（HR）4.49，（95%置信区间（95%CI）2.06 - 9.80）]。相比之下，仅在G4期[HR 3.08（95%CI 1.40 - 6.79）]和G5期[HR 1.43（95%CI 1.01 - 2.05）]发现Hb<10 g/dL的患者发生ESKD的风险增加。未发现较高Hb水平会增加风险。
Hb<10 g/dL的肾性贫血对临床结局的影响因CKD分期而异，在G3期CVE和全因死亡率风险显著升高，在G4和G5期进展为ESKD的风险显著升高。
