Shoji Tetsuo, Niihata Kakuya, Fukuma Shingo, Fukuhara Shunichi, Akizawa Tadao, Inaba Masaaki
Department of Vascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
Institute for Health Outcomes and Process Evaluation research (iHope International), Kyoto, Japan.
Clin Exp Nephrol. 2017 Aug;21(4):685-693. doi: 10.1007/s10157-016-1317-1. Epub 2016 Aug 8.
Serum ferritin concentration >100 ng/mL was associated with a higher risk of death in hemodialysis patients in Japan, whereas such an association was less clear in hemodialysis patients in Western countries. Since Japanese dialysis patients are generally less inflamed than those in Western countries, inflammation may modify the association between serum ferritin and the adverse outcomes.
We performed an observational cohort study using data from 2606 Japanese hemodialysis patients who participated in the Dialysis Outcomes and Practice Patterns Study (DOPPS) III (2005-2008) or DOPPS IV (2009-2012). The predictor was serum ferritin category (<50, 50-99.9, 100-199.9, and ≥200 ng/mL), and the primary and secondary outcomes were all-cause mortality and cardiovascular hospitalization, respectively. C-reactive protein (CRP, cut-off by 0.3 mg/dL) and serum albumin (cut-off by 3.8 g/dL) were stratification factors related to systemic inflammation.
After adjustment for relevant confounding factors, a U-shaped association was observed between serum ferritin and all-cause mortality in the group with low CRP levels, whereas such relationship was not significant in the high CRP counterparts. In contrast, we found a linear association between serum ferritin and cardiovascular hospitalization in the low CRP and high CRP groups commonly. Similar results were obtained when the total cohort was stratified by serum albumin.
Serum ferritin showed different patterns of association with all-cause mortality in hemodialysis patients with versus without inflammation, whereas its association with cardiovascular hospitalization was similar regardless of inflammatory conditions.
在日本，血液透析患者血清铁蛋白浓度>100 ng/mL与较高的死亡风险相关，而在西方国家的血液透析患者中，这种关联不太明确。由于日本透析患者的炎症程度通常低于西方国家的患者，炎症可能会改变血清铁蛋白与不良结局之间的关联。
我们利用参与透析结局和实践模式研究（DOPPS）III（2005 - 2008年）或DOPPS IV（2009 - 2012年）的2606名日本血液透析患者的数据进行了一项观察性队列研究。预测因素为血清铁蛋白类别（<50、50 - 99.9、100 - 199.9和≥200 ng/mL），主要和次要结局分别为全因死亡率和心血管住院率。C反应蛋白（CRP，临界值为0.3 mg/dL）和血清白蛋白（临界值为3.8 g/dL）是与全身炎症相关的分层因素。
在调整相关混杂因素后，低CRP水平组中血清铁蛋白与全因死亡率之间呈现U型关联，而在高CRP水平组中这种关系不显著。相反，我们发现低CRP组和高CRP组中血清铁蛋白与心血管住院率之间均呈线性关联。当根据血清白蛋白对整个队列进行分层时，也获得了类似的结果。
血清铁蛋白在有炎症和无炎症的血液透析患者中与全因死亡率的关联模式不同，而其与心血管住院率的关联在炎症状态不同时相似。
