贫血作为全因死亡率的危险因素：慢性肾脏病的隐匿协同效应
Anemia as a risk factor for all-cause mortality: obscure synergic effect of chronic kidney disease.
作者信息
Sato Yuji, Fujimoto Shouichi, Konta Tsuneo, Iseki Kunitoshi, Moriyama Toshiki, Yamagata Kunihiro, Tsuruya Kazuhiko, Narita Ichiei, Kondo Masahide, Kasahara Masato, Shibagaki Yugo, Asahi Koichi, Watanabe Tsuyoshi
机构信息
Dialysis Division, University of Miyazaki Hospital, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan.
出版信息
Clin Exp Nephrol. 2018 Apr;22(2):388-394. doi: 10.1007/s10157-017-1468-8. Epub 2017 Aug 16.
BACKGROUND
Anemia is common in chronic kidney disease (CKD) and may be associated with mortality in CKD patients. However, few studies have examined this relationship in Asian populations.
METHODS
A total of 62,931 Japanese people (age 64.0 ± 8.0 years; men 38.5%) were followed up from 2008 to 2012. Participants were divided into six groups in accordance with their estimated glomerular filtration rate (eGFR) (<45, 45-59, ≥60 mL/min/1.73 m) and by hemoglobin levels (13.0 g/dL for men; 12.0 g/dL for women). Hazard ratio and confidence interval (CI) for mortality with a combination of eGFR and anemia were calculated. After matching using propensity score (PS) for anemia, survival analysis between anemic and non-anemic people, independent from some variables, including eGFR, was performed.
RESULTS
A total of 828 (1.3%) participants died (non-anemic vs. anemic, 1.2 vs. 2.3%, p < 0.01). Multivariable Cox analysis showed that, independent of eGFR levels, anemic people had significantly higher mortality. Anemic people were found to have significantly poorer survival than non-anemic people as per a log-rank test (p < 0.01) for the PS-matching cohort. Further stratified logistic analysis using PS in the overall cohort odds ratio (95% CI) showed 2.25 (1.89-2.67) with p < 0.01.
CONCLUSION
The results of the present study showed that anemia was an independent risk factor of all-cause mortality.
背景
贫血在慢性肾脏病（CKD）中很常见，并且可能与CKD患者的死亡率相关。然而，很少有研究在亚洲人群中探讨这种关系。
方法
对总共62931名日本人（年龄64.0±8.0岁；男性占38.5%）进行了2008年至2012年的随访。参与者根据其估计肾小球滤过率（eGFR）（<45、45 - 59、≥60 mL/min/1.73 m²）和血红蛋白水平（男性为13.0 g/dL；女性为12.0 g/dL）分为六组。计算了eGFR和贫血联合情况下的死亡风险比和置信区间（CI）。在使用贫血倾向评分（PS）进行匹配后，对贫血和非贫血人群进行了生存分析，该分析独立于包括eGFR在内的一些变量。
结果
共有828名（1.3%）参与者死亡（非贫血与贫血，分别为1.2%与2.3%，p<0.01）。多变量Cox分析表明，独立于eGFR水平，贫血人群的死亡率显著更高。对于PS匹配队列，根据对数秩检验（p<0.01）发现贫血人群的生存率明显低于非贫血人群。在总体队列中使用PS进行进一步分层逻辑分析，优势比（95%CI）为2.25（1.89 - 2.67），p<0.01。
结论
本研究结果表明贫血是全因死亡率的独立危险因素。
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