Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seoul 06591, Republic of Korea.
Division of Nephrology, Yeouido St. Mary's Hospital, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul 07345, Republic of Korea.
Nutrients. 2017 Oct 27;9(11):1177. doi: 10.3390/nu9111177.
Blood manganese (Mn) level has been reported to be higher in patients with anemia or iron deficiency. The purpose of this study was to analyze the relationship between blood Mn level and anemia in patients with chronic kidney disease (CKD). A total of 334 patients with CKD who were not treated with dialysis were included in this study. Blood Mn level and serum markers regarding anemia, renal function, and nutrition were measured and analyzed. Median blood Mn level was 8.30 (interquartile range(IQR): 5.27-11.63) μg/L. Univariate linear regression showed that blood Mn level was correlated with age (β = -0.049, p < 0.001), smoking (β = -1.588, p = 0.009), hypertension (β = -1.470, p = 0.006), serum total iron-binding capacity (TIBC) (β = 0.025, p < 0.001), serum transferrin (β = 0.029, p < 0.001), and estimated glomerular filtration rate (eGFR; β = 0.036, p < 0.001). Results of multiple linear regression analysis showed that beta coefficient of hemoglobin was 0.847 (p < 0.001) for blood Mn level in all participants after controlling for covariates, including gender, age, body mass index, smoking, diabetes, hypertension, and eGFR. Multivariate Poisson regression analysis with robust variance after adjusting for gender, age, smoking, hypertension, diabetes, eGFR, and nutritional markers showed that higher blood Mn level (per 1 μg/L increase) was associated with decreased prevalence of anemia (PR 0.974, 95% CI: 0.957 to 0.992, p = 0.005). Taken together, our results demonstrate that blood Mn level is positively associated with hemoglobin level in CKD patients. This might provide important information in the understanding of the pathogenesis of CKD-related anemia.
血液锰（Mn）水平已被报道在贫血或缺铁的患者中较高。本研究的目的是分析慢性肾脏病（CKD）患者的血液 Mn 水平与贫血之间的关系。本研究共纳入 334 名未接受透析治疗的 CKD 患者。测量和分析了血液 Mn 水平以及与贫血、肾功能和营养有关的血清标志物。中位血液 Mn 水平为 8.30（四分位距（IQR）：5.27-11.63）μg/L。单变量线性回归显示，血液 Mn 水平与年龄（β=-0.049，p<0.001）、吸烟（β=-1.588，p=0.009）、高血压（β=-1.470，p=0.006）、血清总铁结合能力（TIBC）（β=0.025，p<0.001）、血清转铁蛋白（β=0.029，p<0.001）和估算肾小球滤过率（eGFR；β=0.036，p<0.001）相关。多元线性回归分析结果显示，在校正性别、年龄、体重指数、吸烟、糖尿病、高血压和 eGFR 等混杂因素后，所有参与者血液 Mn 水平的血红蛋白β系数为 0.847（p<0.001）。校正性别、年龄、吸烟、高血压、糖尿病、eGFR 和营养标志物后进行多元泊松回归分析，稳健方差显示，血液 Mn 水平每升高 1μg/L，贫血患病率降低（PR 0.974，95%CI：0.957 至 0.992，p=0.005）。综上所述，我们的结果表明，CKD 患者的血液 Mn 水平与血红蛋白水平呈正相关。这可能为理解 CKD 相关贫血的发病机制提供重要信息。
