Eriksson Daniel, Goldsmith David, Teitsson Siguroli, Jackson James, van Nooten Floortje
Quantify Research, Stockholm, Sweden.
Renal Unit, Guy's and St Thomas' NHS Foundation Hospital, London, UK.
BMC Nephrol. 2016 Jul 26;17(1):97. doi: 10.1186/s12882-016-0312-9.
Deteriorating renal function in chronic kidney disease (CKD) patients is commonly associated with reduced haemoglobin levels, adding to the already considerable humanistic burden of CKD. This analysis evaluated the impact of anaemia on disease burden in patients with CKD stages 3-4, and in those on dialysis.
This was a descriptive, cross-sectional analysis of European data from an Adelphi CKD Disease-Specific Programme. This programme collected data from patients and their treating nephrologists/endocrinologists; patient- and physician-reported data were matched for each patient. Health-related quality of life (HRQoL) data were obtained through patient completion of the EQ-5D, SF-12 and KDQOL-36. Additional information was obtained via physician reporting of patient symptoms, and patients' reports of impaired activity. Anaemia was defined by haemoglobin level and/or current use of erythropoiesis stimulating agents.
Significant, but modest Spearman's rank correlations were observed between haemoglobin levels and extent of HRQoL impairment, regardless of instrument used (range 0.19-0.23; all P-values < 0.0001). When stratified by anaemia status, impairment was consistently lower for anaemic than non-anaemic CKD patients across measurement scales (e.g. EQ-5D index value [standard deviation {SD}] 0.72 [0.31] vs 0.83 [0.23], respectively; P < 0.0001). Physician-reported patient tiredness was associated with increased disease burden at all levels of CKD studied (total EQ-5D index value [SD] in patients reporting no tiredness vs tiredness 0.81 [0.26] vs 0.70 [0.30] respectively; P < 0.0001) with P < 0.0001 for no tiredness vs tiredness at all stages of CKD. The presence of anaemia was associated with impaired activity levels at CKD stages 3 (37.5 % vs 28.4 %, respectively; P = 0.0044) and 4 (48.1 % vs 39.9 %, respectively; P = 0.0292), and in patients on dialysis (52.0 % vs 45.0 %, respectively; P = 0.0732).
The analysis found that CKD patients with anaemia typically had a lower HRQoL than those without anaemia. The impairment correlated with anaemia was more apparent in non-dialysis patients with CKD stages 3 or 4 than in those receiving dialysis. Coexisting CKD and anaemia may have an impact on patient HRQoL similar to other chronic conditions such as diabetes, epilepsy or certain forms of cancer.
慢性肾脏病（CKD）患者肾功能恶化通常与血红蛋白水平降低相关，这进一步加重了CKD本已相当大的人文负担。本分析评估了贫血对3 - 4期CKD患者以及透析患者疾病负担的影响。
这是一项对来自阿德尔菲CKD特定疾病项目的欧洲数据进行的描述性横断面分析。该项目收集了患者及其治疗肾病专家/内分泌专家的数据；患者报告的数据与医生报告的数据针对每位患者进行了匹配。通过患者完成EQ - 5D、SF - 12和KDQOL - 36获取健康相关生活质量（HRQoL）数据。通过医生报告患者症状以及患者报告活动受限情况获取其他信息。贫血通过血红蛋白水平和/或当前使用促红细胞生成素进行定义。
无论使用何种工具，均观察到血红蛋白水平与HRQoL受损程度之间存在显著但适度的斯皮尔曼等级相关性（范围为0.19 - 0.23；所有P值<0.0001）。按贫血状态分层时，在所有测量量表上，贫血的CKD患者的受损程度始终低于非贫血患者（例如，EQ - 5D指数值[标准差{SD}]分别为0.72[0.31]和0.83[0.23]；P<0.0001）。医生报告的患者疲劳与所研究的所有CKD水平的疾病负担增加相关（报告无疲劳的患者与疲劳患者的总EQ - 5D指数值[SD]分别为0.81[0.26]和0.70[0.30]；P<0.0001），在CKD的所有阶段，无疲劳与疲劳之间的P值均<0.0001。贫血的存在与CKD 3期（分别为37.5%对28.4%；P = 0.0044）和4期（分别为48.1%对39.9%；P = 0.0292）以及透析患者（分别为52.0%对45.0%；P = 0.0732）的活动水平受损相关。
分析发现，贫血的CKD患者的HRQoL通常低于无贫血的患者。与贫血相关的受损在3或4期非透析CKD患者中比在接受透析的患者中更明显。并存的CKD和贫血可能对患者HRQoL产生与糖尿病、癫痫或某些形式的癌症等其他慢性疾病类似的影响。
