Maruyama Yukio, Yokoyama Keitaro, Yokoo Takashi, Shigematsu Takashi, Iseki Kunitoshi, Tsubakihara Yoshiharu
Division of Nephrology and Hypertension, Jikei University School of Medicine, Tokyo, Japan.
Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
PLoS One. 2015 Nov 23;10(11):e0143430. doi: 10.1371/journal.pone.0143430. eCollection 2015.
BACKGROUND/AIMS: Monitoring of serum ferritin levels is widely recommended in the management of anemia among patients on dialysis. However, associations between serum ferritin and mortality are unclear and there have been no investigations among patients undergoing peritoneal dialysis (PD).
Baseline data of 191,902 patients on dialysis (age, 65 ± 13 years; male, 61.1%; median dialysis duration, 62 months) were extracted from a nationwide dialysis registry in Japan at the end of 2007. Outcomes, such as one-year mortality, were then evaluated using the registry at the end of 2008.
Within one year, a total of 15,284 (8.0%) patients had died, including 6,210 (3.2%) cardiovascular and 2,707 (1.4%) infection-related causes. Higher baseline serum ferritin levels were associated with higher mortality rates among patients undergoing hemodialysis (HD). In contrast, there were no clear associations between serum ferritin levels and mortality among PD patients. Multivariate Cox regression analysis of HD patients showed that those in the highest serum ferritin decile group had higher rates of all-cause and cardiovascular mortality than those in the lowest decile group (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.31-1.81 and HR, 1.44; 95% CI, 1.13-1.84, respectively), whereas associations with infection-related mortality became non-significant (HR, 1.14; 95% CI, 0.79-1.65).
Using Japanese nationwide dialysis registry, higher serum ferritin values were associated with mortality not in PD patients but in HD patients.
背景/目的：在透析患者贫血管理中，广泛推荐监测血清铁蛋白水平。然而，血清铁蛋白与死亡率之间的关联尚不清楚，且尚未对腹膜透析（PD）患者进行过调查。
2007年底从日本全国透析登记处提取了191902例透析患者的基线数据（年龄65±13岁；男性61.1%；透析中位时长62个月）。然后在2008年底使用该登记处数据评估诸如一年死亡率等结局。
在一年内，共有15284例（8.0%）患者死亡，包括6210例（3.2%）死于心血管疾病和2707例（1.4%）死于感染相关原因。较高的基线血清铁蛋白水平与血液透析（HD）患者较高的死亡率相关。相比之下，PD患者的血清铁蛋白水平与死亡率之间没有明确关联。对HD患者进行的多变量Cox回归分析显示，血清铁蛋白处于最高十分位数组的患者全因死亡率和心血管死亡率高于最低十分位数组的患者（风险比[HR]分别为1.54；95%置信区间[CI]为1.31 - 1.81和HR为1.44；95%CI为1.13 - 1.84），而与感染相关死亡率的关联变得不显著（HR为1.14；95%CI为0.79 - 1.65）。
利用日本全国透析登记处数据，较高的血清铁蛋白值与死亡率的关联并非在PD患者中，而是在HD患者中。
