Eisenga Michele F, Nolte Ilja M, van der Meer Peter, Bakker Stephan J L, Gaillard Carlo A J M
Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, P.O. Box 30.001, 9700, RB, Groningen, The Netherlands.
BMC Nephrol. 2018 Sep 12;19(1):225. doi: 10.1186/s12882-018-1021-3.
Iron deficiency is highly prevalent in chronic kidney disease (CKD) patients. In clinical practice, iron deficiency is defined based on a combination of two commonly used markers, ferritin and transferrin saturation (TSAT). However, no consensus has been reached which cutoffs of these parameters should be applied to define iron deficiency. Hence, we aimed to assess prospectively which cutoffs of ferritin and TSAT performed optimally for outcomes in CKD patients.
We meticulously analyzed 975 CKD community dwelling patients of the Prevention of Renal and Vascular Endstage Disease prospective study based on an estimated glomerular filtration rate < 60 ml/min/1.73m, albuminuria > 30 mg/24 h, or albumin-to-creatinine ratio ≥ 30 mg/g. Cox proportional hazard regression analyses using different sets and combinations of cutoffs of ferritin and TSAT were performed to assess prospective associations with all-cause mortality, cardiovascular mortality, and development of anemia.
Of the included 975 CKD patients (62 ± 12 years, 64% male with an estimated glomerular filtration rate of 77 ± 23 ml/min/1.73m), 173 CKD patients died during a median follow-up of 8.0 (interquartile range 7.5-8.7) years of which 70 from a cardiovascular cause. Furthermore, 164 CKD patients developed anemia. The highest risk for all-cause mortality (hazard ratio, 2.83; 95% confidence interval, 1.53-5.24), cardiovascular mortality (4.15; 1.78-9.66), and developing anemia (3.07; 1.69-5.57) was uniformly observed for a TSAT< 10%, independent of serum ferritin level.
In this study, we have shown that of the traditionally used markers of iron status, reduced TSAT, especially TSAT< 10%, is most strongly associated with the risk of adverse outcomes in CKD patients irrespective of serum ferritin level, suggesting that clinicians should focus more on TSAT rather than ferritin in this patient setting. Specific attention to iron levels below this cutoff seems warranted in CKD patients.
缺铁在慢性肾脏病（CKD）患者中极为普遍。在临床实践中，缺铁是根据两种常用指标——铁蛋白和转铁蛋白饱和度（TSAT）综合定义的。然而，对于应用这些参数的哪些临界值来定义缺铁尚未达成共识。因此，我们旨在前瞻性地评估铁蛋白和TSAT的哪些临界值对CKD患者的预后最为理想。
我们基于估计肾小球滤过率<60 ml/min/1.73m²、蛋白尿>30 mg/24h或白蛋白与肌酐比值≥30 mg/g，对975例社区居住的CKD患者进行了细致分析，这些患者来自预防肾脏和血管终末期疾病前瞻性研究。使用铁蛋白和TSAT临界值的不同组及组合进行Cox比例风险回归分析，以评估与全因死亡率、心血管死亡率及贫血发生的前瞻性关联。
纳入的975例CKD患者（年龄62±12岁，64%为男性，估计肾小球滤过率为77±23 ml/min/1.73m²）中，173例患者在中位随访8.0（四分位间距7.5 - 8.7）年期间死亡，其中70例死于心血管原因。此外，164例患者发生了贫血。无论血清铁蛋白水平如何，TSAT<10%时，全因死亡率（风险比，2.83；95%置信区间，1.53 - 5.24）、心血管死亡率（4.15；1.78 - 9.66）和发生贫血（3.07；1.69 - 5.57）的风险均最高。
在本研究中，我们表明，在传统使用的铁状态指标中，TSAT降低，尤其是TSAT<10%，与CKD患者不良结局风险的关联最为强烈，无论血清铁蛋白水平如何，这表明在这种患者情况下，临床医生应更多关注TSAT而非铁蛋白。对于CKD患者，似乎有必要特别关注低于此临界值的铁水平。
Zotero 插件
