Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan R.O.C; Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan R.O.C.
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, Taipei, Taiwan R.O.C; Division of Endocrinology & Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan R.O.C.
J Ren Nutr. 2019 Sep;29(5):444-453. doi: 10.1053/j.jrn.2018.11.004. Epub 2019 Jan 22.
Iron supplementation and erythropoietin stimulating agents (ESAs) are essential for maintaining hemoglobin levels in hemodialysis patients. However, patients with autosomal-dominant polycystic kidney disease (PKD) have higher endogenous erythropoietin levels, so their recommended iron indices for hemodialysis patients may differ. This study evaluated iron profiles, including ferritin levels and transferrin saturation (TSAT) to identify factors affecting mortality in patients on dialysis, and those associated with mortality in patients with and without PKD.
This cohort study from the Taiwan Renal Registry Data System stratified mortality risk by the presence of PKD recorded as the underlying disease.
We enrolled 1346 hemodialysis patients with PKD and 82,873 hemodialysis patients without PKD.
The primary outcome was 3-year all-cause mortality. Predictors included time-averaged and baseline serum ferritin levels and TSAT. Multivariate Cox regression analysis adjusting for age, comorbidities, and relevant laboratory parameters was used to estimate the all-cause hazard ratios (HRs) for mortality.
The mean ages of patients with and without PKD were 56.2±13.2 and 61.7±13.5 years and the median follow-up time was 37 (15-76) months. The adjusted mortality risks for time-averaged ferritin levels >800 ng/mL (HR=1.52; 95% confidence interval: 1.40-1.65) or TSAT levels >50% (HR=1.46; 95% confidence interval: 1.30-1.65) were significantly higher among patients without PKD than those for patients with normal iron indices. However, a U-shaped curve of mortality against ferritin/TSAT levels was not observed in patients with PKD. In the sensitivity test, there was no difference among PKD patients who underwent regular ESA therapy and those who did not.
Iron indices have different effects on mortality among patients with and without PKD. Iron supplementation, recommended serum ferritin levels, or TSAT should be monitored in hemodialysis patients, especially those without PKD. Clinicians should consider treating anemia in hemodialysis patients individually, especially in PKD.
铁补充剂和促红细胞生成素刺激剂（ESAs）对于维持血液透析患者的血红蛋白水平至关重要。然而，常染色体显性多囊肾病（PKD）患者内源性促红细胞生成素水平较高，因此他们的血液透析患者推荐铁指标可能有所不同。本研究评估了铁谱，包括铁蛋白水平和转铁蛋白饱和度（TSAT），以确定影响透析患者死亡率的因素，以及与有和没有 PKD 的患者死亡率相关的因素。
这项来自台湾肾脏登记数据系统的队列研究根据记录为基础疾病的 PKD 的存在对死亡率进行分层。
我们纳入了 1346 名患有 PKD 的血液透析患者和 82873 名没有 PKD 的血液透析患者。
主要结局为 3 年全因死亡率。预测因子包括时间平均和基线血清铁蛋白水平和 TSAT。使用调整年龄、合并症和相关实验室参数的多变量 Cox 回归分析来估计全因死亡率的风险比（HRs）。
有和没有 PKD 的患者的平均年龄分别为 56.2±13.2 岁和 61.7±13.5 岁，中位随访时间为 37（15-76）个月。对于时间平均铁蛋白水平>800ng/mL（HR=1.52；95%置信区间：1.40-1.65）或 TSAT 水平>50%（HR=1.46；95%置信区间：1.30-1.65）的调整死亡率风险在没有 PKD 的患者中明显高于铁指数正常的患者。然而，在 PKD 患者中，铁蛋白/TSAT 水平与死亡率之间没有观察到 U 形曲线。在敏感性测试中，接受常规 ESA 治疗的 PKD 患者和未接受治疗的患者之间没有差异。
铁指标对有和没有 PKD 的患者的死亡率有不同的影响。铁补充剂、推荐的血清铁蛋白水平或 TSAT 应在血液透析患者中监测，特别是在没有 PKD 的患者中。临床医生应考虑根据个体情况治疗血液透析患者的贫血，特别是在 PKD 患者中。
