Boronat Mauro, Santana Ángelo, Bosch Elvira, Lorenzo Dionisio, Riaño Marta, García-Cantón César
Section of Endocrinology and Nutrition, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain.
Nephron. 2017;135(2):97-104. doi: 10.1159/000450892. Epub 2016 Oct 20.
BACKGROUND/AIMS: Different biochemical abnormalities of metabolic bone disease have been associated with anemia of chronic kidney disease (CKD), mainly in hemodialysis patients. However, all of these abnormalities are closely inter-related and their individual effect on the development of anemia is uncertain. This study was aimed to assess the relationship between anemia and a set of metabolic bone disease biomarkers in a cohort of adult patients with advanced non-dialysis-dependent CKD.
The sample consisted of 382 patients submitted to a Nephrology Unit for evaluation of advanced CKD in a tertiary hospital from Gran Canaria during 3 years. Associations between anemia and serum levels of calcium (albumin-corrected), phosphorus, PTH, 25-hydroxivitamin D (25(OH)D3) and alkaline phosphatase were analyzed by using logistic regression models with adjustment for other demographic, clinical and biochemical covariates potentially related to anemia and to bone mineral metabolism.
Serum levels of calcium and 25(OH)D3 (negatively) and phosphorus (positively) were significantly associated with anemia in an unadjusted logistic regression model. In a fully adjusted multivariable model, the OR for anemia was 0.29 (95% CI 0.16-0.49; p < 0.0001) for every 1 mg/dl increase in serum calcium and 2.19 (95% CI 1.55-3.15; p < 0.001) for every 1 mg/dl increase in serum phosphorus. Female sex and lower serum albumin levels were also independently associated with anemia. The inclusion of albumin in the adjusted model displaced the significance of 25(OH)D3.
Circulating levels of calcium and phosphorus are strongly linked to anemia in patients with advanced non-dialysis CKD.
背景/目的：代谢性骨病的不同生化异常与慢性肾脏病（CKD）贫血有关，主要见于血液透析患者。然而，所有这些异常都密切相关，它们对贫血发生发展的个体影响尚不确定。本研究旨在评估一组成年晚期非透析依赖CKD患者中贫血与一系列代谢性骨病生物标志物之间的关系。
样本包括382例患者，他们在3年期间因晚期CKD到大加那利岛一家三级医院的肾病科进行评估。采用逻辑回归模型分析贫血与血清钙（白蛋白校正）、磷、甲状旁腺激素（PTH）、25-羟基维生素D（25(OH)D3）和碱性磷酸酶水平之间的关联，并对其他可能与贫血和骨矿物质代谢相关的人口统计学、临床和生化协变量进行校正。
在未校正的逻辑回归模型中，血清钙和25(OH)D3水平（呈负相关）以及磷水平（呈正相关）与贫血显著相关。在完全校正的多变量模型中，血清钙每增加1mg/dl，贫血的比值比（OR）为0.29（95%可信区间[CI]0.16 - 0.49；p < 0.0001），血清磷每增加1mg/dl，贫血的OR为2.19（95%CI 1.55 - 3.15；p < 0.001）。女性性别和较低的血清白蛋白水平也与贫血独立相关。在校正模型中纳入白蛋白后，25(OH)D3的显著性消失。
晚期非透析CKD患者中，循环钙和磷水平与贫血密切相关。
