日本血液透析患者中经透析间期体重增加校正的血红蛋白水平与死亡率的关系：宫崎透析队列研究
Relationship between Hemoglobin Levels Corrected by Interdialytic Weight Gain and Mortality in Japanese Hemodialysis Patients: Miyazaki Dialysis Cohort Study.
作者信息
Toida Tatsunori, Iwakiri Takashi, Sato Yuji, Komatsu Hiroyuki, Kitamura Kazuo, Fujimoto Shouichi
机构信息
Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
出版信息
PLoS One. 2017 Jan 3;12(1):e0169117. doi: 10.1371/journal.pone.0169117. eCollection 2017.
BACKGROUND
Although hemoglobin (Hb) levels are affected by a change in the body fluid status, the relationship between Hb levels and mortality while taking interdialytic weight gain (IDWG) at blood sampling into account has not yet been examined in hemodialysis patients.
STUDY DESIGN
Cohort study.
SETTING, PARTICIPANTS: Data from the Miyazaki Dialysis cohort study, including 1375 prevalent hemodialysis patients (median age (interquartile range), 69 (60-77) years, 42.3% female).
PREDICTOR
Patients were divided into 5 categories according to baseline Hb levels and two groups based on the median value of IDWG rates at blood sampling at pre-HD on the first dialysis session of the week.
OUTCOMES
All-cause and cardiovascular mortalities during a 3-year follow-up.
MEASUREMENTS
Hazard ratios were estimated using a Cox model for the relationship between Hb categories and mortality, and adjusted for potential confounders such as age, sex, dialysis duration, erythropoiesis-stimulating agent dosage, Kt/V, comorbid conditions, anti-hypertensive drug use, serum albumin, serum C-reactive protein, serum ferritin, and serum intact parathyroid hormone. Patients with Hb levels of 9-9.9 g/dL were set as our reference category.
RESULTS
A total of 246 patients (18%) died of all-cause mortality, including 112 cardiovascular deaths. Lower Hb levels (<9.0g/dL) were associated with all-cause mortality (adjusted HRs 2.043 [95% CI, 1.347-3.009]), while Hb levels were not associated with cardiovascular mortality. When patients were divided into two groups using the median value of IDWG rates (high IDWG, ≥5.4% and low IDWG, <5.4%), the correlation between lower Hb levels and all-cause mortality disappeared in high IDWG patients, but was maintained in low IDWG patients (adjusted HRs 3.058 [95% CI,1.575-5.934]). On the other hand, higher Hb levels (≥12g/dL) were associated with cardiovascular mortality in high IDWG patients (adjusted HRs 2.724 [95% CI, 1.010-7.349]), but not in low IDWG patients.
CONCLUSION
In hemodialysis patients, target Hb levels may need to be selected in consideration of IDWG at blood sampling.
背景
尽管血红蛋白（Hb）水平受体液状态变化影响，但在血液透析患者中，考虑到采血时的透析间期体重增加（IDWG），Hb水平与死亡率之间的关系尚未得到研究。
研究设计
队列研究。
研究地点、参与者：来自宫崎透析队列研究的数据，包括1375例维持性血液透析患者（年龄中位数（四分位间距）为69（60 - 77）岁，女性占42.3%）。
预测因素
根据基线Hb水平将患者分为5类，并根据一周内首次透析治疗前血液透析时IDWG率的中位数将患者分为两组。
结局
3年随访期间的全因死亡率和心血管死亡率。
测量方法
使用Cox模型估计Hb类别与死亡率之间的关系，并对年龄、性别、透析时间、促红细胞生成素剂量、Kt/V、合并症、抗高血压药物使用、血清白蛋白、血清C反应蛋白、血清铁蛋白和血清完整甲状旁腺激素等潜在混杂因素进行校正。将Hb水平为9 - 9.9 g/dL的患者作为参照组。
结果
共有246例患者（18%）死于全因死亡，其中112例死于心血管疾病。较低的Hb水平（<9.0g/dL）与全因死亡率相关（校正后风险比2.043 [95%置信区间，1.347 - 3.009]），而Hb水平与心血管死亡率无关。当根据IDWG率的中位数将患者分为两组（高IDWG，≥5.4%和低IDWG，<5.4%）时，低Hb水平与全因死亡率之间的相关性在高IDWG患者中消失，但在低IDWG患者中仍然存在（校正后风险比3.058 [95%置信区间，1.575 - 5.934]）。另一方面，较高的Hb水平（≥12g/dL）在高IDWG患者中与心血管死亡率相关（校正后风险比2.724 [95%置信区间，1.010 - 7.349]），但在低IDWG患者中不相关。
结论
在血液透析患者中，可能需要考虑采血时的IDWG来选择目标Hb水平。
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