Kim Taehee, Rhee Connie M, Streja Elani, Obi Yoshitsugu, Brunelli Steven M, Kovesdy Csaba P, Kalantar-Zadeh Kamyar
Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California, Irvine, School of Medicine, CA, USA.
Department of Medicine, Inje University, Busan, South Korea.
Nephrol Dial Transplant. 2017 Feb 1;32(2):370-377. doi: 10.1093/ndt/gfw012.
The rise in serum ferritin levels among US maintenance hemodialysis patients has been attributed to higher intravenous iron administration and other changes in practice. We examined ferritin trends over time in hemodialysis patients and whether iron utilization patterns and other factors [erythropoietin-stimulating agent (ESA) prescribing patterns, inflammatory markers] were associated with ferritin trajectory.
In a 5-year (January 2007–December 2011) cohort of 81 864 incident US hemodialysis patients, we examined changes in ferritin averaged over 3-month intervals using linear mixed effects models adjusted for intravenous iron dose, malnutrition and inflammatory markers. We then examined ferritin trends across strata of baseline ferritin level, dialysis initiation year, cumulative iron and ESA use in the first dialysis year and baseline hemoglobin level.
In models adjusted for iron dose, malnutrition and inflammation, mean ferritin levels increased over time in the overall cohort and across the three lower baseline ferritin strata. Among patients initiating dialysis in 2007, mean ferritin levels increased sharply in the first versus second year of dialysis and again abruptly increased in the fifth year independent of iron dose, malnutrition and inflammatory markers; similar trends were observed among patients who initiated dialysis in 2008 and 2009. In analyses stratified by cumulative iron use, mean ferritin increased among groups receiving iron, but decreased in the no iron group. In analyses stratified by cumulative ESA dose and baseline hemoglobin, mean ferritin increased over time.
While ferritin trends correlated with patterns of iron use, increases in ferritin over time persisted independent of intravenous iron and ESA exposure, malnutrition and inflammation.
美国维持性血液透析患者血清铁蛋白水平的升高归因于静脉铁剂使用增加及其他实践中的变化。我们研究了血液透析患者铁蛋白水平随时间的变化趋势，以及铁利用模式和其他因素[促红细胞生成素刺激剂（ESA）处方模式、炎症标志物]是否与铁蛋白变化轨迹相关。
在一个为期5年（2007年1月至2011年12月）的队列中，纳入81864例美国初诊血液透析患者，我们使用线性混合效应模型，对静脉铁剂剂量、营养不良和炎症标志物进行校正，以研究3个月间隔内铁蛋白的平均变化。然后，我们研究了基线铁蛋白水平、透析起始年份、首个透析年份的累积铁和ESA使用情况以及基线血红蛋白水平各分层中的铁蛋白变化趋势。
在校正了铁剂剂量、营养不良和炎症的模型中，总体队列以及三个较低基线铁蛋白分层中的平均铁蛋白水平均随时间升高。在2007年开始透析的患者中，透析第一年与第二年相比，平均铁蛋白水平急剧上升，且在第五年再次突然升高，与铁剂剂量、营养不良和炎症标志物无关；在2008年和2009年开始透析的患者中也观察到类似趋势。在按累积铁使用情况分层的分析中，接受铁剂治疗的组平均铁蛋白升高，但未接受铁剂治疗的组平均铁蛋白降低。在按累积ESA剂量和基线血红蛋白分层的分析中，平均铁蛋白随时间升高。
虽然铁蛋白变化趋势与铁使用模式相关，但随着时间推移，铁蛋白升高持续存在，与静脉铁剂和ESA暴露、营养不良及炎症无关。
